Major Depression, Case Study Example

Because there are many causes of depression, it is important to thoroughly evaluate a patient to determine if the mood disorder is precipitated by an event or events or whether it is generated by a chemical imbalance.  This paper will discuss the case study of a woman who has presented with symptoms of depression, and explore the indicated treatment options, both pharmacological and non-pharmacological.

The cause of the patient’s depression is most likely due to the death of her husband less than one year prior.  Given the change in her personality as well as her appearance, and the length of time since the event this would be more than an adjustment disorder which is typically a reaction to an event within the three months prior to the depression (DSM-IV.) Instead, this woman demonstrates classic symptoms of Major Depressive Disorder, as evidenced by the presenting symptoms: weight loss, change in appearance and personality, suicidal ideation, sadness, and a change in her personal grooming (DSM-IV.)

This client would require several clinical interventions. First, I would assess for suicidality to determine whether or not the client is at imminent risk of making a suicide attempt; this would include determining whether she has an actual plan for self-harm and if so, whether or not she has access to the instruments of that plan.  If indeed those responses were positive, I would have her evaluated at the emergency room to see whether or not hospitalization would be indicated to keep her safe (American Psychiatric Association.)  Next, I would have her begin a trial of anti-depressants, since she exhibits many symptoms that are favorable to that option, such as weight loss, difficulty sleeping, and her moderate to severe symptoms (Pharmacist’s Letter/Prescriber’s Letter.) My preference would be one of the SSRI’s because trials have demonstrated their superiority over placebos, in addition to being relatively fast-acting and well tolerated.  My choice would be Prozac, because that has been approved by the FDA for the longest period of time for that category of anti-depressants, so that a great deal is known about its effects, side effects, and exactly how to monitor patients who are on it.

I would conduct several non-pharmacological interventions as well.  I would obtain a thorough history of the patient, including past mental health issues or problems as well as family history of the same.  It would also be crucial to the therapeutic contact to begin to form a strong alliance with this woman in order to increase the likelihood that she would comply with the treatment as well as begin to view me as an important source of support and acceptance.  Literature supports the concept that there is a strong connection between the therapeutic alliance and a positive psychotherapeutic outcome as well as a strong therapeutic alliance and the success of pharmacotherapy (Krupnick et al.) My goal would be to engage this client in a strong, positive relationship characterized by a nonjudgmental attitude, confidentiality, empathy and respect.

In treating this person, it would be important to consider her co-morbid conditions such as hypertension, weight loss, as well as other depressive symptoms, another reason for beginning our treatment plan by having her examined by a medical doctor to determine how those conditions might be contributing to or resulting from her major depression.  In addition, prescribing Prozac would also make it important to monitor those conditions because changes in appetite, weight, as well as other physical changes are included in some of the side effects of this medication.  It would be vital to establish a baseline of her health before prescribing this, or any other medications.  Finally, I would also consider having her create a contract agreeing to refrain from harming herself without first contacting me or a suicide hotline number which I would give to her.  We would both signed that contract although that would be far from any guarantee that she would comply with it, it could be helpful to reinforce her ability to stop herself and reach out to a supportive person who can help her in a crisis.

Works Cited:

American Psychiatric Association. Practice Guideline for the Treatment of Patients with Major Depressive Disorder, 3rd ed. Arlington: American Psychiatric Association, 2010.

DSM-IV. Washington, DC: American Psychiatric Association, 1994.

Krupnick, Janice, et al. “The Role of the Therapeutic Alliance in Psychotherapy and Pharmacotherapy Outcome: Findings in the National Institute of Middle Health Treatment of Depression Collaborative Research Program.” Focus (2006): 269-277: http://focus.psychiatryonline.org/article.aspx?articleid=50607.

Pharmacist’s Letter, Prescribers Letter. Depression Guidelines: Overview of Pharmacotherapy. Stockton: Pharmacist’s Letter / Prescriber’s Letters, 2010.