A nurse in an acute care mental health facility is caring for a client who has major depressive disorder. Which of the following actions by the client indicates that the treatment has been effective?

Introduction: Effective treatment for major depressive disorder is evidenced by the resolution of core symptoms such as hopelessness, social withdrawal, and anhedonia. Improvement is noted when the client moves from internalized ruminations to externalized communication, demonstrating an improved ability to engage with their environment and utilize healthy coping mechanisms. A. Preoccupation with one's own thoughts is a sign of withdrawal and rumination, which are hallmark symptoms of active depression. This indicates that the client is still mentally isolated and has not yet achieved a therapeutic response to the pharmacological or psychotherapeutic interventions provided. B. Excessive seeking of reassurance is often a manifestation of low self-esteem and high anxiety, common in the acute phase of depression. Effective treatment should lead to increased self-confidence and emotional autonomy, reducing the client's need for constant external validation from staff or family members. C. Difficulty sleeping (insomnia or hypersomnia) is a physical symptom of depression. If the client continues to report sleep disturbances, it indicates that the underlying neurochemical imbalance has not been fully corrected and that the treatment plan may need adjustment to achieve complete symptomatic remission. D. Expressing feelings is a positive behavioral change that indicates treatment effectiveness. It shows that the client is no longer utilizing total emotional suppression or withdrawal. Verbalizing emotions is a key component of the therapeutic process and indicates an improvement in energy levels and cognitive clarity.