Depressive disorders cause huge burdens on the level of the individual as well as the society. Major depressive disorder is the most prevalent psychiatric disorder with catastrophic consequences including disability and death. However, communicating with depressed clients exhibits specific challenges and requires skillful execution. Depressed clients may be less likely to ask questions or advocate for themselves. You as a nurse play a huge role in gathering crucial information from clients and performing this skillfully promotes change and improves client outcomes.

Marvin, a 29-year-old African-American male was voluntarily admitted to the inpatient psychiatry unit after a suicide attempt by asphyxiation through carbon monoxide that was aborted by his roommate.

His past psychiatric history includes major depressive disorder with anxious features. His chart states his mental health concerns started many years ago and that he had been receiving treatment for the past 4 years. He denied a history of other psychiatric disorders. With this latest attempt, his parents stated he posted suicidal thoughts on social media a few weeks prior.

His past medical history included mild obesity. He does not use tobacco, alcohol, or other recreational substances.

His current depressive episode began approximately 14 months prior to admission when he experienced significant psychosocial stressors at work and, without seeking medical assistance, discontinued his antidepressant treatment (escitalopram). Since that time, he experienced persistent negative thoughts and suicidal ideation, difficulty coping, low mood, guilt, irritability, and worry. Six months prior to admission he independently re-initiated his escitalopram which was self-reported to have reduced his irritability and temper. He achieved some stability in his mental health until 1 month prior to admission when, without an identifiable trigger, he experienced a sudden decline in his mood which culminated in a suicide attempt.

On admission, Marvin reported feeling numb, a loss of joy and interest in activities, and difficulty coping. It appears he hasn’t showered in several days, if not more. He has spent the entire evening in his room, sleeping since arriving onto the unit.

Tasks
Use Marvin’s scenario to address the following:
How would you as the nurse respond therapeutically to a depressive ruminative thought?
How would you assess Marvin’s behaviors?
What communication techniques and guidelines would you incorporate in interacting with Marvin?
Which neurovegetative symptoms of depression is Marvin exhibiting? What in his behavior supports these symptoms? How would these symptoms differ if Marvin experienced atypical vegetative syndrome?
What kind of questions could you ask to elicit if Marvin has low physical energy?
What kind of questions could you ask to elicit if Marvin is suicidal?
As Marvin’s friends and family come to visit him, how would you advise them of Marvin’s condition?