Depression as the Mental Health Issue - Research Paper Example

? Final Project: Intervention II Psychology Submitted Determination of the Mental Health Issue Ms. A, 28 year old, married business executive lady suffers from depression as the mental health issue. This diagnosis is made secondary to the adherence of DSM IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) which specifies the criteria that needs to be fulfilled prior to categorizing a patient as suffering from any mental health condition. DSM IV asserts that before classifying an individual as having depression, the individual needs to have 5 or greater than 5 of the following symptoms. Consequently, the symptoms need to have been present within a 2-week interval and have to be accompanied by loss of pleasure performing activities that previously were a source of pleasure and the individual having depressed mood (Chapman & Perry, 2008). Among the symptoms outlined in DSM IV classification of major depression include; the individual having a depressed mood. Secondly, the individual should assert having lost pleasure in performing activities that were previously pleasurable to the individual. Moreover, the individual should have a significant reduction or gain in weight. Consequently, the individual should suffer from hypersomnia or insomnia and complain of feeling fatigued. Also, the individual may present with retardation or psychomotor agitation. Another symptom is that the individual may assert of feeling worthless and avowing inappropriate guilt which will be coupled by impaired concentration. In extreme cases, the individual may have recurrent suicidal thought and tendencies (Diagnostic and statistical manual of mental disorders, 4th ed. 1994). Upon using DSM IV classification of depression in the case study, it is evident that Ms. A has more than one of the outlined symptoms. Firstly, she complains of nervousness and feeling worried every time her husband travels and especially this time he left for three months. Also, Ms. A has insomnia as she asserts to have difficulty in sleeping and has to consume over the counter drugs to help her sleep. Thirdly, Ms. A has lost 15 pounds of weight in the three months her husband was on a business trip and fourthly, she complains of being irritable. A fifth symptom that Ms. A has is that she is irritable evidencing agitation and since she thinks that her husband will leave her, this evidences that she has feelings of worthlessness. Moreover, Ms. A asserts to have reduced libido which illustrates that she has loss in activities that were pleasurable in the past. Use of DSM IV to classify Ms. A as having chronic depression is therefore viable since she has more than 5 of the symptoms that are outlined in DSM IV (Diagnostic and statistical manual of mental disorders, 4th ed. 1994). Having classified Ms. A as having chronic depression, it is thus important to select the pharmacological treatment approach that will be effective to use on Ms. A. Selection and explanation of pharmacological treatment approach As evidenced by symptoms of depression, it can be noted that depression is not only a disorder but also a syndrome. This asserts that the goal of treatment in depression patients is aimed at alleviating the patient of the depressing symptoms of depression. This therefore means that the goal of the pharmacological treatment approach designed will be aimed at alleviating Ms. A from the distressing symptoms. Consequently, it is important to advice Ms. A that she has to take the treatment regime till six months are over even after the symptoms reduce. This is since depression has a high recurrence rate hence necessitating the need for long time pharmacological intervention especially in case of relapse of the symptoms (Robert, Greg and Steven, 2008). Antidepressant medications which are also known as ADM fall into four main classifications. These are two older pharmacologic interventions and two newer pharmacologic interventions. Among the older pharmacologic interventions include (MAOIs) monoamine oxidase inhibitors and (TCAs) tricyclic antidepressants. The newer generation includes (SSRIs) selective serotonin reuptake inhibitors and (SNRIs) serotonin/ noradrenalin- reuptake inhibitors with the former being the most prescribed type. This therefore means that the main ADM that Ms. A needs to be prescribed is SSRI which she will have to take for six months as ADM have previously been described as suppressing symptoms and not curative (Hollon, Thase, and Markowitz 2002). Depression results from imbalance of neurotransmitters namely serotonin, dopamine and noradrenalin which form the monoamine system. Pathology of depression occurs following the fast degradation of these neurotransmitters especially in the limbic system which is responsible for emotional responses, appetite, sleep and sexual interest. Lack of neurotransmitters to transmit impulses to the limbic system result in Ms. A presenting with the depressive symptoms. However, following the pharmacologic intervention of SSRIs, TCAs and SNRIs, they prevent the breakdown of the neurotransmitter hence long exposure for the excitation of the limbic system. This culminates to patient having increased appetite, elated mood, and pleasurable activities and also emotional stability that is absent in depressed individuals. This is how the ADMs will work in reversing the symptoms that Ms. A presents with leading to the diagnosis of depression (Hollon, Thase, and Markowitz 2002). Despite the beneficial effect of ADM, it is also important to address the side effects of these drugs that result from alteration of the reuptake of neurotransmitters and on the limbic system. How selected treatment approach will alter brain chemistry and influence behavior As has been earlier indicated through the mode of action of ADM, they mainly act on the limbic system and alter the neurotransmitters in the brain. This is the brain chemistry meaning that the nerve fibers will be excited more than normal to alleviate the depression symptoms that Ms. A presents with. By altering the brain chemistry, the effect will be presented in the behavior exhibited by Ms. A. To begin with, Ms. A will have an elated mood and may be emotional since the emotion center in the limbic system will be excited. This means that she will no longer present with nervousness and iritatibility. Consequently, she will perceive herself as being of more self worth and will not think that her husband is leaving her when he goes for business trips (Raymond et al. 2012). Following alteration in the neurotransmitter brain chemistry, Ms. A will have a different feeding behavior. Appetite is controlled by the limbic system and following prolonged excitation, Ms. A will have a higher appetite compared to previous instances. This means that her feeding behavior will be elated and she will end up gaining more weight as a result. In addition, Ms. A complained or reduced libido following depression. Since sexual pleasure and interest is controlled by the limbic system, Ms. A will have a different sexual behavior. Following restored sexual pleasure; she will have increased libido and her sexual life will be better than it was previously. Also, her sleep pattern will be changed. Since she used to have difficulty in sleeping, altered brain chemistry will cause sedation that will lead her to falling asleep more often and thus restored sleep pattern (Raymond et al. 2012). Incase the altered brain chemistry and behavior is left unchecked, Ms. A will have side effects necessitating need to review the side effects of the selected pharmacological treatment. Anticipated Side Effects of Selected Pharmacological Treatment Antidepressants have been associated to have five major side effects upon administration to patients who are diagnosed to have depression. Daytime sedation is one of the side effects that Ms. A may experience upon using prescribed antidepressants. This is associated to the fact that the medications are used to treat the insomnia that the patient perceives and the inability to sleep. Ms. A may thus experience daytime insomnia as a result of increased sedation to treat the insomnia. Ms. A may also experience anxiety and agitation as a side effect to the chosen pharmacological intervention. This is since the treatment regime was meant to treat nervousness and here irritability, the side effect being making her nervous and anxious not only about herself but also about her body and other around her. Moreover, vomiting is another side effect that Ms. A may perceive following pharmacological intervention. This is attributed to the weight loss and upon administration of appetite inducing property of antidepressants; Ms. A in turn vomits a lot as a side effect of the drugs. Headache is another side effect that has been documented following use of antidepressant s to treat depression and thus Ms. A may experience headaches as a side effect of the pharmacologic intervention (Raymond et al. 2012). Ways of Managing Drug Side Effects Drug side effects can be managed by administration in low doses depending on the severity of the symptoms. Also, there is need to note that pharmacologic intervention is not the only treatment regime that is available for Ms. A. Cognitive treatment is another treatment modality that can be used to minimize the side effects since its combination with pharmacologic intervention ensures that antidepressants are issued in low doses. One such form of therapy is interpersonal therapy which is a form of psychotherapy and Ms. A will be engaged in counseling to try and identify predisposing factors to developing depression and how these factors can be curtailed. ECT (Electroconvulsive therapy) is another form of therapy that can be used to prevent the adverse side effects and also to treat depression. This is since the major mode of action is stimulating the vagus nerve and thus ensuring that Ms. A gets over her depressed mood and perceives pleasure in activities that were un-pleasurable following depression. There is need to embrace cognitive therapy since it is not only an alternative form of therapy, it is also a way that can be used to minimize side effects of drugs following pharmacologic interventions (Robert, Greg and Steven, 2008). Description of How the Use of Over-The-Counter and Illicit Drugs Effect Pharmacological Treatment Ms. A asserts to have used illicit drugs in her early 20s though she no longer uses them now. However, her previous use of illicit drugs can counter the effectiveness of the pharmacologic intervention designed for Ms. A. Illicit drugs are known to have tolerance that leads to dependence of the individual on consuming the drugs. Moreover, illicit drug predispose an individual to psychosis and upon withdrawal lead to depression. There is thus a possibility that Ms. A suffering from depression is secondary to withdrawal from the use of illicit drugs. This therefore means that there is a possibility of adverse effects of the drugs like anxiety and agitation predisposing Ms. A to take the illicit drugs. This will further potentiate the effect of the ADM and may lead to adverse health effects and consequential withdrawal symptoms that may further aggravate her depression (Complton, et al., 2006). Ms. A asserts that she uses over the counter drugs when she is unable to sleep. This means that she has over the counter sedatives that she uses. These over the counter sedatives will potentiate the effect of ADM since they have sedation effects to counter insomnia culminating to excessive sedation of Ms. A. Moreover, majority of the over the counter drugs have antihistamine effects that has negative drug interaction with ADM predisposing Ms. A to bleeding tendencies. It is therefore important to enlighten Ms. A on the importance of adherence to the ADM prescribed and lack of continued use of the over the counter drugs (Complton et al. 2006). Conclusion Depression is a major psychiatric condition that though common among the elderly population, its incidence and prevalence has been found to be on the rise among young adults. Ms. A is one such adult who upon presenting with nervousness, reduced libido, reduces weight of 15 pounds, fatigue irritability and reduced libido is diagnosed to have depression based on DSM IV. The selected pharmacologic intervention is the use of TCAs, SSRIs, and NSRIs whose mode of action is blocking the degeneration of neurotransmitters in the limbic system. This alters the brain chemistry and behavior of Ms. A since she will have an elated mood, increased libido, increased appetite, increased sexual pleasure, and increased self worth. However, adverse effects of the drug include headache, daytime sedation, insomnia, and nausea. These side effects can be curtailed by the use of other alternative forms of treatment like the use of cognitive therapy. It has also been noted that Ms. A should no longer use illicit drugs and over the counter drugs since they potentiate the effects of ADM. In finality, it is important to advice Ms. A on the long course of treatment and importance of adherence to ADM for six months to reduce chances of relapse. It is also important to emphasize on the need to combine pharmacological interventions with cognitive interventions for optimal treatment of depression. References Compton M. Conway P. Stinson S. Grant F. (2006). “Changes in the prevalence of major depression and comorbid substance use disorders in the United States between 1991-1992 and 2001-2002.” Am J Psychiatry ;163(12):2141–2147. Chapman D, and Perry G. (2008). “Depression as a Major Component of Public Health for Older Adults”. Prev Chronic Dis; 5 (1): A22. Diagnostic and statistical manual of mental disorders. 4th ed. (1994).Washington (DC): American Psychiatric Association. Hollon S, Thase M, Markowitz J. (2002). “Treatment and prevention of depression.” Psychol Sci Public Interest; 3: 39–77. Raymond W, Erin E, David J, Edwin M, Auby A, and Lakshmi N. (2012). “Which Depressive Symptoms and Medication Side Effects are perceived by Patients as Interfering most with Occupational Functioning?” Depression Research and Treatment: 1D (630206), 6 pages. Doi:10.1155/2012/630206. Robert J, Greg S, and Steven D. (2008), “Cognitive therapy vs. medications for depression: Treatment outcomes and neural mechanisms”, Nat Rev Neurosci; 9 (10): 788-796. Read More