major depressive disorder, a major disorder of mood characterized by a persistent dysphoria, anxiety, irritability, fear, brooding, appetite and sleep disturbances, weight loss, psychomotor agitation or delay, decreased energy, feelings of worthlessness or guilt, difficulty in concentrating or thinking, possible delusions and hallucinations, and thoughts of death or suicide. The disorder, which occurs in children, adolescents, and adults, may develop over a period of days, weeks, or months. Episodes may occur in clusters or singly, separated by several years of normality. The causes of the disorder are multiple and complex and may involve biological, psychological, interpersonal, and sociocultural factors that lead to an unidentifiable intrapsychic conflict. Treatment includes use of antidepressants and electroconvulsive therapy, followed by long-term psychotherapy. Nursing care is needed to ensure adequate nutrition, appropriate balance of fluid intake and output, good personal hygiene, and protection of the patient from self-injury. Occupational therapy practitioners help persons with major depressive disorders engage in daily living tasks (e.g., feeding, dressing, bathing, grooming, and hygiene), education, play, medication management, meal preparation (instrumental activities of daily living), and leisure by developing habits and routines that support participation in life events. Practitioners help clients develop patterns of engagement that provide a healthy balance. Also called major affective disorder, unipolar disorder. See also bipolar disorder, depression, dysthymic disorder.
