A nurse is caring for a client who has major depressive disorder and recently started taking antidepressants. Which of the following client statements should the nurse identify as the priority?

Major depressive disorder is a mood disorder characterized by persistent low mood, anhedonia, cognitive disturbances, and in severe cases, suicidal ideation or preparatory behaviors. When clients begin antidepressant therapy, nurses must closely monitor for increased suicide risk, especially early in treatment when energy may improve before mood does. Certain statements may indicate imminent self-harm risk and require immediate priority intervention. Safety is always the highest priority in mental health nursing. Rationale: A. “I barely have enough energy to get out of bed in the morning” reflects typical depressive symptoms such as fatigue, low motivation, and psychomotor slowing. While this indicates ongoing depression severity, it does not suggest immediate risk of harm. It requires monitoring and support but is not the highest priority compared to suicidal preparation behaviors. B. “I am giving away my belongings to my friends” is a major warning sign of suicidal ideation and preparatory behavior. This action often indicates that the client may be organizing affairs in anticipation of self-harm or death. In recently starting antidepressants, this significantly increases concern for suicide risk and requires immediate safety intervention and assessment. C. “I have lost interest in having sexual intercourse with my partner” reflects anhedonia and possible medication side effects such as decreased libido. This is a common symptom of depression and certain antidepressants, but it is not an indicator of immediate danger. It is important for long-term management but not the priority concern. D. “I feel guilty about how my depression is affecting my family” reflects feelings of worthlessness and excessive guilt, which are common cognitive symptoms of depression. While clinically important, it does not indicate immediate self-harm risk. It should be addressed therapeutically but is secondary to behaviors suggesting potential suicide planning.