A client with a 10-year history of unipolar major depression has relapsed and is now hospitalized. The client is currently on phenelzine and weighs 115 lb (52.1 kg) but weighed 150 lb (68 kg) 3 months prior to admission. Which foods would be the best for this client?

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Reduced appetite and significant, unintentional weight loss are included in the diagnostic criteria for unipolar major depression (major depressive disorder). A 35-lb (15.9-kg) weight loss within 3 months is a 23% change in this client's usual body weight and is considered severe weight loss. The client needs a diet high in calories and protein to promote adequate nutrition and weight gain. In addition, the client has a diagnosis of depression and may have a low energy level; providing foods that are easier to chew and swallow may be better choices for promoting intake. Foods that are protein and/or calorie dense include: Whole milk and dairy products (eg, milkshakes), fruit smoothies Granola, muffins, biscuits Potatoes with sour cream and butter Meat, fish, eggs, dried beans, almond butter Pasta/rice dishes with cream sauce (Option A) The client is taking phenelzine (Nardil), which is a monoamine oxidase inhibitor (MAOI). Foods high in tyramine (eg, aged cheese, yogurt, cured meats, fermented foods, broad beans, beer, red wine, chocolate, avocados) need to be restricted to reduce the risk of a hypertensive crisis. (Option B) This choice is an excellent protein option but is low in calories. The client needs foods high in calories and protein. (Option D) This choice provides calories but is low in protein and high in tyramine. The client needs to consume foods that are high in calories and protein but low in tyramine. Educational objective: Clients with unipolar major depression are likely to have reduced appetite and unintentional weight loss. Interventions to promote adequate nutritional intake include providing small frequent meals and snacks that are dense in protein and calories. In addition, drug-nutrient interactions need to be considered when choosing foods for a client on an MAOI.

A Client with a 10-Year History of Unipolar Major Depression