Nursing Field Notes / Mental Health · Psychiatric Care
Depression: Signs & Symptoms 🌧️
NG-031
MENTAL HEALTH
ADHD-friendly visual edition
Major Depressive Disorder (MDD), also called clinical depression, is when a client experiences a severe depressed mood, loss of enjoyment in life, low energy & a few other critical signs and symptoms. Everything is low & slow — it is thought to be from low levels of neurotransmitters within the brain.
📄 Simple Nursing original — opens in Drive →
⬇️ Low & slowLow Serotonin · Dopamine · Norepinephrine.
🔢 5 of 9 = MDDDiagnosis needs 5 or more symptoms.
🚫🎉 Anhedonia“Things I once did for pleasure aren’t fun.”
😠 Teens ACT OUTIrritability, outbursts, skipping class — not just sadness.
🧨
CAUSE
STEP 1 · WHY IT HAPPENSThree neurotransmitters run low — and the whole client runs low with them.
🧠 Pathophysiology: the three tanks are low
🧠 “Sad Dogs Nap” = Serotonin · Dopamine · Norepinephrine — all three down, so the client is low & slow.
⚠️ Risk factors
- Stressful life event ATI
- Substance abuse disorders
- Chronic illness
- Genetics: Family history
- Female
🧠 “SAD GF” — Stress · Addiction (substance abuse) · Disease (chronic illness) · Genetics · Female.
ATI QUESTION
…a risk factor for depression?
✅ Stressful life events
…a risk factor for depression?
✅ Stressful life events
📝 Exam call-out: the life-event stressor
KAPLAN QUESTION
Client has recently become unemployed and reports feeling depressed. The nurse understands which statement to be true?
✅ Unemployment is a significant potential stressor
Client has recently become unemployed and reports feeling depressed. The nurse understands which statement to be true?
✅ Unemployment is a significant potential stressor
🧠 Lost job, lost house, lost person → stressor. If the stem hands you a life event, that is the risk factor.
🔎
CLUES
STEP 2 · COUNT TO FIVENine symptoms exist — you only have to count five of them to land on MDD.
🔢 Diagnosis: how many symptoms? HESI · ATI
HESI ATI Diagnosis: 5 or more symptoms out of the 9.
🩺 The 9 signs & symptoms of MDD
1
😞 Depressed mood
(hopeless, empty)
(hopeless, empty)
2
🚫🎉 Anhedonia
(loss of joy / interest in life)
(loss of joy / interest in life)
3
⚖️ Weight loss (anorexia) or Wt. Gain
4
🐢 Psychomotor retardation NCLEX TIP
Slower speech, response time, & Decreased movement
Slower speech, response time, & Decreased movement
5
🛏️ Insomnia or hypersomnia (sleeping too much)
6
🔋 Fatigue (Anergia)
7
😔 Feelings of worthlessness or Guilt
8
🌫️ Difficulty concentration
9
🚨 Suicidal thoughts (Recurrent)
assess it directly, every time — this is the finding you report
assess it directly, every time — this is the finding you report
🧠 “SIG E CAPS” + depressed mood covers all 9 → Sleep (5) · Interest/anhedonia (2) · Guilt/worthlessness (7) · Energy/anergia (6) · Concentration (8) · Appetite/weight (3) · Psychomotor (4) · Suicidal thoughts (9).
🗣️ Anhedonia — hear it in the quote HESI
Q1: “Life just doesn’t have any joy in it anymore. Things I once did for pleasure aren’t fun.”
✅ Answer: Anhedonia
🧠 An-hedonia = “no hedonism.” No pleasure, no fun, no interest — the joy switch is off.
🛏️ The sleep complaint they test HESI
Q2: Which complaint regarding sleep would the nurse expect from a patient diagnosed with major depression?
✅ “I wake up about 4 am and cannot go back to sleep. I feel tired all the time”
🧠 4 a.m. and wide awake 🌑 — early-morning waking + tired all day is the depression sleep answer (insomnia or hypersomnia both count).
🐢 Psychomotor retardation, unpacked NCLEX TIP
🗣️ Slower speech
▼
⏱️ Slower response time
▼
🚶 Decreased movement
🧠 Low neurotransmitters → low & slow client. Speech slow, answers slow, body slow — that is psychomotor retardation.
🧒
CATCH IT
STEP 3 · WHO TO SCREENKids and teens don’t look sad — they look angry, tired, and suddenly different.
🧒 Side note — Pediatrics NCLEX TIP
Adolescents 10 – 19 years
- 😠 Angry, aggressive outbursts & vandalism / skipping class
- 😴 Napping during day
- ⚖️ Weight loss or gain — “suddenly” “rapidly”
- 🙍 Low self-esteem (withdrawal)
🧠 Teens ACT OUT, adults shut DOWN. On peds items, anger + skipping class + a sudden change is depression until screened otherwise.
👤 Adult presentation vs 🧒 Adolescent presentation
| 👤 ADULT (the 9) | 🧒 ADOLESCENT 10–19 | |
|---|---|---|
| Mood 🙂↔️🙁 | Depressed mood — hopeless, empty | Irritability · angry, aggressive outbursts |
| Behavior 🎭 | Psychomotor retardation — slow speech & movement | Vandalism / skipping class · withdrawal, low self-esteem |
| Energy 🔋 | Fatigue (Anergia) | Anergia · napping during day |
| Interest 🚫🎉 | Anhedonia — lost joy in life | Anhedonia — quits the team / the hobby |
| Appetite ⚖️ | Weight loss (anorexia) or gain | Appetite changes — weight change “suddenly” “rapidly” |
🧠 The 4 A’s of the teen 🅰️ — Anger (irritability) · Anergia · Anhedonia · Appetite changes. That is the ATI select-all, word for word.
📝 ATI QUESTION Assessing an adolescent who has depression — which findings should the nurse expect? (Select all that apply)
✅ Irritability
✅ Anergia
✅ Anhedonia
✅ Appetite changes
⭐ TOP Missed NCLEX QUESTION — which pediatric clients should the nurse screen for depression? (Select all that apply)
✅ 😴 10 year old taking frequent naps during class time
✅ 🚫🎉 16 year old quit the chess team despite being the team captain
✅ 😠 14 year old sent home from school due to angry outbursts & skipping class
✅ ⚖️ 17 year old suddenly lost 15 lbs (6.8 kg) in 4 weeks → 48.2 kg
🧠 Nap · Quit · Rage · Drop. Four teens, four disguises, one screen: depression.
⚡
QUICK RECALL
SAY IT OUT LOUD⬇️ Serotonin · Dopamine · Norepinephrine= low & slow
🔢 5 or more of 9= MDD diagnosis
🐢 Slow speech + slow movement= psychomotor retardation
🚨 Recurrent suicidal thoughts= symptom 9 — assess & report it
🎯 Cover & check — 4 rapid-fire questions
Q1: Client says “Life just doesn’t have any joy in it anymore. Things I once did for pleasure aren’t fun.” Name the symptom.
Anhedonia — loss of joy / interest in life.
Q2: How many symptoms are needed to diagnose MDD?
5 or more of the 9 symptoms.
Q3: Which sleep complaint would the nurse expect in major depression?
“I wake up about 4 am and cannot go back to sleep. I feel tired all the time.”
Q4: Four findings to expect when assessing an adolescent with depression?
Irritability · Anergia · Anhedonia · Appetite changes (the 4 A’s).
📌
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