Major Depression: A Case Study

A major depressive episode is not a disorder in itself, but rather more of a description or symptoms of part of a disorder most often depressive disorder or bipolar. A person suffering from a major depressive episode must have a depressed mood or a loss of interest in daily activities consistently for a minimum of a two-week time span (Psych Central, 2013). In diagnosing the mood must reflect a change from the person’s normal mood. A person’s daily activities and functions, such as work, social routines and friends, education, family, and relationships must also have been negatively impacted by the change in their mood. A major depressive episode is also identified by presence of five or more of the following symptoms. The patient can show signs of significant weight loss or weight gain even not dieting or trying to lose or gain weight. The patient will also display a change in appetite almost everyday, either with an increase or a decrease in their normal eating habits. The weight change is typically set at an increase or decrease in weight of more than 5% per month. The patient will display a depressed mood almost the entire day and this sadness, emptiness, loneliness, crying, and distant is observed by others or indicted by the patient, is typically

The following essay is a case study of a client named John who is suffering from major depression and was sent to see me for treatment by his concerned wife. I will provide brief background information about John then further discuss interventions and strategies I believe can be applied in each session with my client in order to make John's life more manageable. In the essay, I will be writing as the therapist, and the sessions are based on a ten week period.

296.32 (F33.1) Major Depressive Disorder, recurrent episode, moderate severity, with anxious distress. Ms. Client meets eight of the nine diagnostic criteria for Major Depressive Disorder (MDD). Specifically, during several periods of time she experienced depressed mood, diminished interest in things she enjoyed to do, hypersomnia, psychomotor agitation, fatigue, feelings of worthlessness, decreased concentration, and suicidal thoughts without intent. Additionally, as Ms. Client expressed, these symptoms are source of continuing distress and interfere with her academics and social functioning. Also, her symptoms started four years prior to the psychological assessment and persisted intermittently since then, lasting for several weeks to several months, with the most recent period of extended length (enduring two weeks) approximately one year ago. Since the last episode she has experienced these symptoms for two to three days at a time. Although the last episode that met the criterion of two weeks duration occurred approximately a year ago, the symptoms have not disappeared, but they occur periodically since then and when they do, they cause considerable distress and impairment in functioning. Thus, the disorder cannot be coded as ‘in partial or full remission’. The specifier ‘with anxious distress’ was given, because Ms. Client reports feelings of difficulty in concentration because of worry and restlessness.

When conducting the psychosocial assessment on the patient, I found out that the patient has been diagnosed depression since the death of his mother in 2009. Since the death of his mother, the patient stated that his functioning has declined. The patient stated that he lived with his mother all his life and after his mother death, he was never the same. He stated that he seek treatment at Cornell hospital and is currently taking quetiapine. He stated that he has not been eating and sleeping properly for many days since the death of his mother.

Depression is associated with “significant disability”, mortality and substantial health care costs affecting nearly 840 million people globally and 14.8 million Americans (Anglin, et al., 2013). The estimated economic burden to the United States is $210 billion per year (Greenberg, 2015). Depression can have several forms ranging from major with a single episode of repeated episodes of persistent (lasting for at least 2 years) (nami.org, n.d.). Depression can occur after trauma, with the onset of winter and declining sunlight (seasonal affective disorder (SAD)), post partum or situational (nimh.nih.gov, n.d.). There is a familial tendency to depression and “females, blacks, Hispanics and persons between the ages of 45-64” are more commonly affected (nami.org, n.d.; vitamindcouncil.org, 2013). Individuals with chronic diseases such as heart disease, arthritis, diabetes, an inability to maintain normal weight and a healthy lifestyle are more likely to be diagnosed with depression (vitamindcouncil.org, 2013). Treatment commonly consists of medication and/or psychotherapy, exercise, light therapy, brain

Depression is defined by the DSM-IV as a mental disorder characterized by sustained depression of mood, anhedonia, sleep and appetite disturbances, feelings of worthlessness, guilt, and hopelessness. Depressive symptoms such as the mere inability to experience pleasure and loss of energy persisting for longer than two weeks are usually enough to indicate an affective disorder (Hirschfeld 2014). There are significant variations in presentations and diagnosis criteria, but regardless of the classification of depressive states (Major (Unipolar), Bipolar, Dysthymia, Atypical, SAD, Postpartum), it is agreed upon that pharmacological interventions are sometimes required: to alleviate debilitating symptoms and improve patients’ quality of life. The interest in depression medications reflects the gravity of the disease i.e. its ability to psychologically impair lives and lead to suicide.

This medication is the drug of choice for this patient since the use in treating depression is well established.

Based on the DSM-V (2013) diagnostic criteria Keisha experiences Persistent Depressive Disorder 300.4 (F34.1), recurrent, moderate, with early onset. The client experiences the following symptoms: depressed mood for most of the day, for more days than not, as indicated by either subjective accounts (e.g., feels sad, worthless and hopeless) or observation by others (e.g. appears sad, cries), for at least one year (she is an adolescent). In addition, while depressed, there is a presence of the following symptoms: the client experiences poor appetite, she is eating one or two meals per day and lost ten pounds in one year. Keisha also experiences hypersomnia nearly every day by sleeping twelve or more hours per night. The client reports low energy/fatigue very often, even though she is sleeping well during the night. During the one year period of disturbance, the individual has never been without the symptoms in criteria A and B for more than two months at a time. In addition, the criteria for a major depressive disorder has been continuously present for one year. There has never been a manic episode or a hypomanic episode, and criteria have never been met for cyclothymic disorder. Furthermore, the disturbance is not better explained by a persistent schizoaffective disorder, schizophrenia, delusional disorder, or other specified or

Major depression is the second ranking disability causing disease in the United States and eleventh in the world (Coryell, 2016). Some common signs and symptoms are frequent depressed mood, difficulty concentrating and loss of enjoyment or interest in daily activities. The person may experience an unintentional weight loss or gain, defined as more than

Erin informed me that over a period of several months she had been feeling increasingly down, tired, and hopelessness. She exhibited more than five of the DSM-IV-TR (American Psychiatric Association, 2000) criteria for Major Depressive Disorder, Recurrent, namely a depressed mood most of the day, a diminished interest in pleasurable activities, loss of appetite, difficulties in initiating and maintaining sleep, resting more often(often sleeping 7 hours on days off), a loss of energy and fatigue, feelings of worthlessness and hopelessness. Other symptoms (i.e. anxiety attacks, inability to concentrate, headaches, self-judging, being hard for herself, irritability, impatient with family, withdrawing from activities- no longer gym attender) were also better accounted for by her depression rather then other diagnosis. She reported occasional suicidal thoughts but did not think she would carry them out and had no plan for doing so because of her kids.

Depression can be further broken down into several different types such as: major depressive disorder, dysthymic disorder, postpartum depression, psychotic, bipolar and seasonal affective. It is important to understand that depression does not look the same on every individual and that there are different forms of depression that affect people. For the purposes of this literature review in relation to the case study on M.P. the focus will be on major depressive disorder and depression with psychotic features. According to the National Institute of Mental Health (2016) major depressive disorder is a serious mood disorder with symptoms that have a significant impact on a person’s affect, cognition, sleep hygiene, appetite, and activities of daily living. For a diagnosis to be made these presenting symptoms must be ongoing for a minimum of two weeks. Furthermore, psychotic depression “occurs when a person has severe depression plus some form of psychosis, such as having disturbing false fixed beliefs (delusions) or hearing or seeing upsetting things that others cannot hear or see (hallucinations). The psychotic symptoms typically have a depressive

Ellen has presented with several clinically significant facts. She has been referred because of continuing depressed mood and panic attacks. She is 37 and lives alone. She is described as an unhappy looking woman. Ellen has been at depression levels since 14, when she attempted suicide. She is in a PhD program, but has not made progress on her thesis in three years. She has had trouble maintaining a job and has been a student must of her adult life. She reports periods of chronic depression, but also high periods that last several months. In these manic episodes, she sleeps little, is constantly on the phone and feels her thoughts racing. Her friends and colleagues fear for her during these periods.

Sarah presents with more than enough relevant symptoms and signs often associated with Criterion A, for a diagnosis of Major Depressive Disorder with a recurrent episode. Based on the duration of her symptoms and the fact that she mentions having previous episodes of depression in the past, further reinforced this diagnosis. It is important to note that none of her symptoms are attributed to any medical conditions or etiology. With no current or past history of alcohol or substance abuse/use, it is clear that these symptoms and signs have caused a change of previous functioning as noticed by her sister Gloria. Sarah reported having a depressed mood with crying spells lasting all day, for more than several weeks. Her recurrent (Criterion A1) suicidal ideation without a specific plan are explained as she reported being close to taking all the pills in her medicine cabinet. In this depressed mood, she also reports having chronic feelings of profound emptiness. This essential feature of MDD, along with her self reporting of (Criterion A2) loss of appetite as evidenced by her not going out to buy groceries to eat, could have also contributed to her rapid weight loss. Sarah reported having no energy to do anything and only watching television in bed, which can also be seen as a sign that meets (Criterion A3) of extreme fatigue. Her reporting of not bathing for a week can also meets (Criterion A4) of markedly diminished interest

Antidepressants are the medication which mostly functions on the neurotransmitters, especially serotonin, norepinephrine or dopamine (National Institute of Mental health, 2011). Although the pathway how the antidepressants biochemically work is still unclear, its effect on the mood regulation is undeniable. As mentioned above, some of the antidepressants, which affects on serotonin neurotransmitter, are called selective serotonin reuptake inhibitors (SSRIs). The most current popular SSRIs are fluoxetine (Prozac), sertraline (Zoloft), escitalopram (Lexapro), paroxetine (Paxil), and citalopram (Celexa) (National Institute of Mental health, 2011). Also, there are some other antidepressants that work on norepinephrine such as venlafaxine (Effexor) and duloxetine (Cymbalta); some antidepressants that work on dopamine such as bupropion (Wellbutrin) (National Institute of Mental health, 2011). There are some old medication, which can be prescribed for depressed patients under some circumstances. These medications are tricyclics and MAOIs. Tricyclics are powerful medication, however, it can cause heart disease, drowsiness, dry mouth, and weight gain as side effects (National Institute of Mental health, 2011). MAOIs, in other hand, can be used in abnormal depression such as overeating or oversleeping. Noticeably, when taking MAOIs with SSRIs, it can lead to serious side effects such as

Jessica is a twenty-eight-year-old married female who works at a large hospital. She has high expectations for herself because she has graduated with honors at both college and medical school. For the past few weeks, she has been feeling tired and unhappy. She has had a demanding and high stressful job at a large hospital for two years. She feels that she is unable to perform well at her job and has trouble concentrating at work and at home. She is uninterested in her usual activities and has many negative thoughts that keep her awake at night. Two diagnoses that best fit this case study are Major Depressive Disorder and Generalized Anxiety Disorder.