07 Mood Disorders

Mood Disorders: Core Patterns

Mood disorders involve persistent or recurring changes in mood, energy, and activity that interfere with daily life. Assessment looks beyond how a person feels in one interview: symptom patterns over time, functioning, medical conditions, prescribed medicines, substance use, and safety all matter.

The main distinction is between depressive episodes and episodes of mood elevation. Major depressive disorder involves depressive episodes. Bipolar disorders involve mania or hypomania, often alongside depression. This distinction is important because treatment planning and safety needs can differ.

Recognizing and Supporting Depression

A Major depressive episode includes depressed or irritable mood, or loss of interest or pleasure, along with other possible symptoms: changes in sleep or appetite, low energy, difficulty concentrating, feelings of worthlessness or guilt, psychomotor changes, or thoughts of death. Symptoms occur most of the day, nearly every day, for at least 2 weeks and cause distress or impaired functioning.

Depression does not look the same for everyone. Some people chiefly describe physical complaints, irritability, withdrawal, or difficulty meeting responsibilities. Assessment should therefore include daily functioning and physical needs, not only a direct report of sadness.

Treatment commonly includes psychotherapy, medication, or both, chosen with the person’s preferences and clinical needs in mind. Nurses can support engagement, monitor symptoms and adverse effects, and encourage consultation with the prescriber before starting or stopping medication. Follow-up is especially important after medication begins or a dose changes.

Bipolar Disorders and Mood Elevation

Bipolar I disorder includes at least one manic episode. Bipolar II disorder involves hypomanic and major depressive episodes. Depressive episodes in bipolar disorders can resemble major depression, so asking only about current low mood may miss an important part of the history.

Mania may involve markedly elevated or irritable mood, increased energy or activity, decreased need for sleep, rapid speech, racing thoughts, distractibility, inflated self-esteem, and risky behavior. Hypomania is less severe; a person may feel unusually productive and may not see the change as a problem. Ask about past periods of unusually high energy, reduced sleep, impulsivity, and changes noticed by others.

Medical conditions, prescribed medicines, and alcohol or other drugs can mimic or worsen mood symptoms. Treatment typically combines medication and psychotherapy. Mood stabilizers and some antipsychotic medicines are commonly used. When antidepressants are used for bipolar depression, they are generally not used alone because they may trigger mania or rapid cycling. Encourage adherence and prompt reporting of side effects or emerging mania; medication should not be stopped without consulting the prescriber.

Regular sleep and daily routines, mood tracking, and avoiding alcohol and non-prescribed drugs can support ongoing care.

Suicide Risk and Immediate Safety

Suicide risk can occur with depression, bipolar disorder, substance use, and other forms of distress. Ask directly and calmly about thoughts of suicide; asking does not cause suicidal thoughts. If a person reports thoughts, explore current intent, plan, access to means, past attempts or self-injury, recent changes, substance use, supports, and reasons for living. A history of suicidal behavior is an important risk factor. Follow organizational screening and assessment procedures, and reassess when symptoms, circumstances, or level of care change.

If danger is imminent or there has been a recent attempt, stay with the person, notify the appropriate clinical team immediately, and follow emergency procedures. Reduce access to potential means of harm in accordance with policy. Collaboratively develop a practical Safety plan, identify supportive contacts, and arrange follow-up. A promise or “no-suicide contract” is not a substitute for assessment and a safety plan.

In the United States, call or text 988 for crisis support; call 911 for an immediate life-threatening emergency.

Nursing Care and Communication

Therapeutic communication helps preserve dignity and support engagement. Use a calm, nonjudgmental approach, listen, acknowledge distress, and ask open questions such as, “What has been hardest for you lately?” Avoid minimizing statements such as “Cheer up” or “You have so much to be grateful for.”

For a person with depression, assess mood, sleep, appetite, energy, concentration, daily functioning, substance use, psychotic symptoms, and suicide risk. Check nutrition, hydration, and ability to complete self-care. Offer simple choices, break care into manageable steps, and encourage activity and social contact gradually. Reinforce strengths and progress without expecting rapid improvement. Coordinate follow-up and involve chosen supports with the person’s consent when appropriate.

For a person experiencing mania, prioritize safety, sleep, hydration, nutrition, and reduced stimulation. Use brief, clear, concrete statements and set consistent, respectful limits on unsafe or disruptive behavior. Avoid arguing about grandiose ideas or giving long explanations; redirect attention and offer structured, low-stimulation activities. Monitor impulsivity, judgment, agitation, exhaustion, intake, and possible psychosis. Portable, nourishing foods and fluids may help when sitting for meals is difficult, consistent with the care plan. Report escalating symptoms, inability to sleep, dangerous behavior, or adverse effects promptly.

Across mood states, coordinate with the interprofessional team, document observed behavior and the person’s own words, and provide education in brief, understandable steps.

Key Takeaways

Depression involves persistent low mood or loss of interest with other symptoms and impaired functioning. Bipolar disorders include mania or hypomania, often alongside depression, so a history of mood elevation matters when planning care. Nursing priorities include empathetic communication, monitoring symptoms and functioning, supporting treatment, and addressing suicide risk directly. Imminent danger requires immediate protective action and escalation.