Nurses in any area of practice in the community frequently are the first health care professionals to recognize behaviors consistent with mood disorders. In some cases, a family member may mention distress about a client’s withdrawal from activities; difficulty thinking, eating, and sleeping; complaints of being tired all the time; sadness; and agitation (all symptoms of depression). They might also mention cycles of euphoria, spending binges, loss of inhibitions, changes in sleep and eating patterns, and loud clothing styles and colors (all symptoms of the manic phase of bipolar disorder). Documenting and reporting such behaviors can help these people to receive treatment. Esti-mates are that nearly 40% of people who have been diag-nosed with a mood disorder do not receive treatment (Akiskal, 2005). Contributing factors may include the stigma still associated with mental disorders, the lack of understanding about the disruption to life that mood disor-ders can cause, confusion about treatment choices, or a more compelling medical diagnosis; these combine with the reality of limited time that health care professionals devote to any one client.
People with depression can be treated successfully in the community by psychiatrists, psychiatric advanced practice nurses, and primary care physicians. People with bipolar disorder, however, should be referred to a psychia-trist or psychiatric advanced practice nurse for treatment. The physician or nurse who treats a person with bipolar disorder must understand the drug treatment, dosages, desired effects, therapeutic levels, and potential side effects so that he or she can answer questions and promote com-pliance with treatment.