Major Depressive Disorder - Case Study Example

 Major Depressive Disorder Introduction Jeff is a 43-year-old man born and raised in Cleveland. He is the only male child and the youngest of three children. His father held the titles of vice president and general manager at the small manufacturing firm he worked in until his retirement seven years ago while his mother held several secretarial jobs on a part-time basis. One of his older sisters is divorced, lives in San Francisco and is an oncologist by profession whereas, the younger one of the two has no job and is married to a real estate agent. Jeff’s father was strict, quick to criticize, slow to render praise or recognition, and was domineering over his wife. Jeff has his own family whereby, he is married to Renee and together they have two daughters. They live in an upper-middle class suburb. He is a mechanical engineer by profession and is employed as a design manager at an automobile corporation in Detroit whereas, his wife Renee is an assistant principal of an elementary school. From an early age he loved cars taking it up as a full-time career as an adult. His passion extends the formal working environment whereby, he restores cars in his fully equipped garage, subscribes to 11 car magazines and watches a car race every weekend. He also serves as the vice president of the Motor City Chapter of the Tri-Chevy Association. PART A Diagnosis: Major Depressive Disorder, Single episode, Melancholic type Criteria A At least five of the following symptoms have been present during the same 2-week period and represent a change from previous functioning: at least one of the symptoms is either 1) depressed mood or 2) loss of interest or pleasure (DSM V). Jeff displayed six of the symptoms listed below meeting the criteria for Major Depressive Disorder, Single Episode, Melancholic type. 1. Depressed mood most of the day, nearly every day, as indicated either by subjective report (e.g., feels sad or empty) or observation made by others (e.g., appears tearful) (DSM V). Jeff’s friend Bill gave Jeff the psychiatric referral after noticing his dramatic change in mood. Over the last few months his moods worsened with each passing day. 2. Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day (as indicated either by subjective account or observation made by others) (DSM V). Jeff reported feeling empty and unmotivated to engage in the things, which he found interesting previously. “My give-a-crap-meter is on zero”, were the exact words he used to describe his feelings towards everything. 3. Significant weight loss when not dieting or weight gain (e.g., a change of more than 5% of body weight in a month), or decrease or increase in appetite nearly every day (DSM V). 4. Insomnia or hypersomnia nearly every day (DSM V). 5. Psychomotor agitation or retardation nearly every day (observable by others, not merely subjective feelings of restlessness or being slowed down) (DSM V). 6. Fatigue or loss of energy nearly every day (DSM V). Jeff reported feeling fatigued on a daily basis. He claimed he had no energy to sustain his interest while engaging in different activities such as working or restoring the dilapidated Corvette. 7. Feelings of worthlessness or excessive or inappropriate guilt (which may be delusional) nearly every day (not merely self-reproach or guilt about being sick) (DSM V). Jeff narrated an incident from work where his team submitted an unusable design. Feelings of guilt surged within him despite knowing the design flaw was not his fault. 8. Diminished ability to think or concentrate, or indecisiveness, nearly every day (either by subjective account or as observed by others) (DSM V). Jeff’s relationship with his colleagues at work indicates a problem with his leadership skills. His indecisiveness, diminished ability to concentrate created a non-conducive working environment for his colleagues whereby, an engineer transferred to another department and the secretary became aloof and hostile. 9. Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or specific plan for committing suicide (DSM V). Jeff’s recurrent suicidal thoughts persisted over the last few weeks. He contemplated different methods of killing himself and ranked them by analyzing the repercussions each method would have on his family. It was clear that Jeff had no malicious motive of committing suicide, in fact as he toyed with the idea, he settled for the option guaranteed to result in minimal disturbance in the family (crashing into a bridge support with the Camaro). Criteria B The symptoms do not meet criteria for a mixed episode (DSM V). Jeff reported that he had not struggled with depressive feelings before the last few months. Criteria C The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (DSM V). Jeff reported heightened disinterest in his hobbies whereby, he gave up restoring the dilapidated Corvette, which he had acquired in the previous year. He also failed to attend events planned by his club; the Motor City Chapter of the Tri-Chevy Association, in the last two months. Jeff recently began using sickness as an excuse to miss work. In addition, Jeff reported that his relationship with his wife and daughters felt strained. He no longer enjoyed playing with the children before they slept. In order to escape Renee’s judgmental stare, Jeff retreated to the garage where he sat in silence and stared into the distance. Criteria D The symptoms are not due to the direct physiological effects of a substance (e.g. a drug of abuse, a medication) or a general medical condition (e.g., hypothyroidism) DSM V). Jeff reported no recent use of substances such as medication. Criteria E The symptoms are not better accounted for by bereavement, i.e., after the loss of a loved one, the symptoms persist for longer than 2 months or are characterized by marked functional impairment, morbid preoccupation with worthlessness, suicidal ideation, psychotic symptoms, or psychomotor retardation (DSM V). Jeff reported no recent bereavement in his family and his job. In fact, he recently got a promotion at work, which meant an increase in responsibilities and a bump in salary. PART B Models of the factors of the disorder (psychological and biological) Jeff’s depressive state is attributable to psychological factors and not biological factors. Information from his personal history does not highlight any history of depression among other family members ruling out the role of genetic factors in predisposing Jeff’s depression. However, using the Psychoanalytic and Parental Acceptance-Rejection models prove crucial in understanding the root cause of Jeff’s problems. The psychoanalytic model advanced by Sigmund Freud presumes that past childhood experiences and unconscious motives influence behaviors exhibited by individuals. Freud was of the opinion that conflicts recur in an individual’s life. Jeff’s recent work promotion at work triggered his depressive episode because he unconsciously associated personal growth, progress or advancement with negativity. As a child, Jeff’s father criticized mistakes and showed minimal acknowledgment towards any of his children’s achievements. The Parental acceptance-rejection theory (PAR Theory) is a socialization theory that attempts to explain and predict global causes, implications and other correlates arising from parental acceptance or rejection (Botta & Dumlao, 2002). Furthermore, the theory tries to expound on the impact of parental acceptance or rejection in influencing the formation and duration of other primary inter-personal relationships such as intimate or romantic adult relationships. The theory does not discriminate against any parent (mother and father). Jeff’s father was domineering, strict and readily criticized his children. PART C Therapy Successful treatment of Jeff’s depression required the combination of psychopharmacological and psychotherapeutic interventions. However, it was pivotal to first confirm that Jeff in deed was suffering from depression. The Beck Depression Inventory (BDI) and Hamilton Rating Scale for Depression (HRSD) confirmed that Jeff was suffering from Major Depressive Disorder. The consulting psychiatrist prescribed a daily dose of 10mg of paroxetine, which is an SSRI. This was to be increased to 20mg in the next week and used for the next six months in order to prevent Jeff’s relapsing. Interpersonal Therapy (IPT) is most often used on a one-on-one basis to treat depression or dysthymia (a more persistent but less severe form of depression). The current manual- based form of IPT used today was developed in the 1980's by Gerald Klerman, M.D., and Myrna Weismann, M.D. This is a time-limited treatment for major depression that addresses the connection between interpersonal problems and mood. IPT varies depending on the needs of the patient and the relationship between the therapist and patient. Basically, a therapist using IPT helps the patient identify troubling emotions and their triggers. The therapist helps the patient learn to express appropriate emotions in a healthy way. The patient may also examine relationships in his or her past that may have been affected by distorted mood and behavior. Doing so can help the patient learn to be more objective about current relationships. The premise of IPT is that treating depression results from improving communication patterns and the ways people relate to each other. The interpersonal problem areas focused on include: • Role transition • Role dispute • Grief • Interpersonal deficits IPT lasts for 12-20 weeks and its main goal is building better social support through the modification of interpersonal problems. In relation to Jeff’s case, IPT focused on helping him develop leadership skills needed to successfully transition into his new managerial post. Initially, Jeff struggled with excessive guilt every time his team received negative criticism whether or not he was to blame for the mistake. IPT will help Jeff develop coping skills in the face of criticism. Moreover, it will help him find lasting solutions to his interpersonal deficits; for example, his negative attitude towards achievement. References Botta, R., & Dumlao, R. (2002). How do conflict and communication patterns between fathers and Health Communication, 14(2), 199-219. Corner R. (2010). Fundamentals of Abnormal Psychology, Worth Publishers. Read More