Page 2263 - Saunders Comprehensive Review For NCLEX-RN

17. Increased use of substances such as alcohol or drugs
D. Major depressive disorder
1. Depressed mood or loss of pleasure in activities for at
least 2 weeks
2. Impaired social, occupational, and/or educational
functioning
3. Mood change from person’s baseline
4. Daily, experiences at least 5 of the of the following
symptoms:
a. Irritability or depressed mood most of
the day, nearly every day (subjective
report or observation of others)
b. Decreased interest or pleasure in most
activities
c. Significant weight change (5%) or
change in appetite
d. Change in activity level
e. Fatigue or loss of energy
f. Guilt/worthlessness
g. Diminished ability to think or
concentrate, or more indecisive
h. Thoughts of death or suicide

E. Interventions (Box 65-7)

For a client at risk for self-harm, ask the client directly, “Have you thought of

hurting yourself?”
X. Electroconvulsive Therapy (ECT)
A. Description
1. ECT is an effective treatment for depression (not a
cure); a small amount of an electrical current is
delivered through electrodes attached to the temples
that cause a brief seizure within the brain; outward
movement is usually a slight movement of the hands,
feet, or a toe, because premedication is given to relax
the muscles. In addition, a short-acting anesthetic is
given.
2. The usual course is 6 to 12 treatments given every 2 to
5 days; maintenance ECT once a month may help
decrease the relapse rate for a client with recurrent
depression.
3. ECT is not always effective in clients with dysthymic
depression, depression and personality disorders,
drug dependence, or depression secondary to
situational or social difficulties.
4. At-risk clients include clients with recent myocardial

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