The Response of Depression to Therapy, Medication, and Lifestyle Changes - Case Study Example

Response of Depression to Therapy, Medication and Lifestyle Changes Student’s Name Institutional Affiliation Response of Depression to Therapy, Medication and Lifestyle Changes Mental health encompasses a broad field of mental illness that have various presentations. Among them is depression where individuals’ mood is low with lack of interest in activities that can build their well-being, feelings, behaviour and thought (National Collaborating Centre for Mental Health [NCCMH], 2010). Among the determinants of depression are social conditions or elements that can limit social connectedness, social networks, social capital and social trust. These elements are components of social inclusion (VicHealth, 2006). Management of depression entails the use of both pharmacological and non-pharmacological therapy. Besides, health promotion to enhance social inclusivity of the depressed individual is salient to successful management of depression (Timonen, 2008). This essay shall examine the response of depression to various forms of management measures based on a case study of M. Case Study of M M is a 31-year-old divorced female mother with three children the youngest been W who has trouble sleeping so much that she keeps her awake most of the nights struggling to get W to sleep. She had divorced a year ago and she kept blaming herself for the divorce. She and her husband had different interests with the husband been more into sports and M preferring shopping and fashion conscious, differences that constantly created a relationship rift between them. Three years ago she had resumed her college studies that her husband had been substantially financing but after the divorce she has had to rely on university grand-in-aid, student loans, and her ex-husband’s child support payment. When M was asked to outline and describe the events and circumstances leading to the occurrence of the son’s sleep problems, it was apparent that the situation overwhelmed her, and she felt exasperated and incapable of handling the son. During the initial interview, it was apparent that she had a depressed mood since the divorce with feelings of sadness, lonely and hopeless. The sombre mood aggravated to the extent that she had to withdraw from her university classes eight months after the divorce as she could not concentrate in class. College withdrawal magnified her situation as her eligibility for student loan was nullified in addition to been expected to pay back her loans. M had nothing to cheer her up as she had lost interest in friendly activities and interaction with her friends, and she felt her children were a huge burden. She even asserted that her return to school had precipitated the divorce as her husband had to perform most of the family roles. She had gained weight and most of her clothes no longer fit her. Two weeks after her first appointment in the mental health centre, discontinuation of her financial aid that had been supporting the payment of her mortgage was devastating. A routine filling of gas in her car enabled a mechanic to identify a cracked exhaust advising her to facilitate the fixing mentioning that it could "lead to quite a good death". It is then that the thought of death stuck in her mind. Management of M M seems to be suffering from mild depression according to DSM-IV criterion for the diagnosis of depression (Dziegielewski, 2010). She has had a persistently depressed mood almost every day for previous two weeks before reporting to the mental health centre, she had also lost interest in most activities, had gained weight significantly, she felt worthless, and her concentration ability had substantially decreased. She had socially isolated her life hence the need for health promotional activities geared to enhancing social inclusivity to change her lifestyle to be more accommodative of social elements. Other management options include the use of antidepressant medications and other forms of psychotherapy. Psychotherapy and Social Inclusion This is a time-limited form of therapy that is commonly administered to patients as outpatients. A form of psychotherapy is deemed ‘efficacious and specific’ if existing high-quality evidence from at least two settings suggest that the therapy is superior to another bonafide treatment, psychological placebo or a pill (Halverson, 2015). For a given therapy to be deemed ‘efficacious’ research evidence from at least two settings should suggest that it is better and acceptable compared to any other treatment while for a given form of therapy to be deemed ‘possibly efficacious’ existing research evidence from at least one study in a single setup should suggest effectiveness of the intervention (Halverson, 2015). Therefore, the therapy administered to any patient should have support from literature to avoid exposing patients to unnecessary and ineffective psychotherapeutic interventions. Based on the above definitions, examples of psychotherapies that have demonstrated efficacy and specificity include "behavioural activation, cognitive behavioural therapy [CBT], problem solving therapy [PST] and interpersonal psychotherapy [IPT]" (Hollon & Ponniah, 2010). IPT is one form of psychotherapy that M received in the first few weeks after her maiden appointment. IPT it is usually limited to 16 sessions of therapy when managing depressive disorder such as in M’s case. Even though it has a more a structured approach to treatment than other forms of dynamic treatments its structure is less compared to behavioural and cognitive approaches. The foundation of IPT arises from attachment theory as it places substantial emphasis on the impact of the patient’s interpersonal relationship to depression (Law, 2011). Areas emphasised during management of M included interpersonal deficits, role transition, interpersonal disputes and grief. The interpersonal aspect has its basis in the social learning theory that suggest that social skills and interpersonal relationships have a role in development and sustenance of depression (Law, 2011). The first four sessions focussed on creating a working alliance before specific interventions were applied to address M’s social deficits in the fifth to 12th session. The therapy sessions, therefore, focussed on enhancing the activity level of M and assist her to acquire and adopt novel social skills. Inactivity, rumination and social isolation were primary interactive components that aggravated M's depression resulting in her increased withdrawal from friends and activities. Therefore, M was encouraged to embrace various activities including horse riding, an activity that she identified to be fun through an interactive discussion when she was asked to list activities she enjoyed doing, to interrupt and possibly reverse depression arising and worsened by the interactive components mentioned above. Response patterns incorporating parenting skills and interpersonal communication were developed to assist her cope better with future events that might stress her. This is paramount since better and more effective communication in addition to enhanced social activity has been demonstrated to enhance supportive social network significant in ameliorating the effect of events in her life that are stressful such as the impact of the divorce and the burden to raise her three children (Cuijipers, van Straten, Andersson & van Oppen, 2008). M was encouraged to apply for a part-time job vacancy in one of the local riding stations that entailed exercising and feeding horses. The job was advantageous to her since she was allowed free unlimited riding sessions, an activity she loved. The job was a salient source of social capital and support to her in that her moods begun to improve a week after getting the job. Later, her father also voluntarily begun supporting her mortgage payment and he became close to her forming a needed source of intra-community capital (VicHealth, 2006). The social capital was also enhanced when her mood improved and she begun engaging in increased communication with individuals at the local riding session. Creation of new relationships strengthened her social connectivity. Pharmacotherapy Pharmacological therapy is usually administered for about two to twelve weeks if the patient adheres adequately to therapy (Halverson, 2015). Medication choice is informed by the tolerability and anticipated safety to the patient so that compliance is enhanced and treatment failure is limited (Kendrick & Peveler, 2010). Among the antidepressant medication that can be used include selective serotonin reuptake inhibitors (SSRIs), atypical antidepressants, tricyclic antidepressants (TCAs), Monoamine oxidase inhibitors (MAOIs) and St. John's wort. SSRIs are better tolerated by most patients compared to the other antidepressants because of their minimal side-effect profile. Also, their dosing is simpler and more compliant with patients, with limited toxicity even during overdose (Halverson, 2015). M was introduced to antidepressant medication when the suicidal ideation was becoming evident after the discontinuation of her financial aid even though the risk was not lethal. M was prescribed Fluoxetine, an SSRI with limited side effects such as weight gain that would otherwise have aggravated her already increasing weight (Halverson, 2015). Three weeks after the initiation of the pharmacological intervention, her mood was brightening and her social network begun to expand six weeks later as she managed to re-establish some of her previous friendship. Conclusion Psychosocial therapy and pharmacological therapies are essential interventions in the management of depression. Psychosocial therapy incorporating the enhancement of social inclusivity of the patient has demonstrated better treatment outcome (Moos, 2007). Incorporation of pharmacological therapy, when suicidal risks or ideation are increasing, is also essential in enhancing treatment outcome. Therefore, a combination of pharmacological and non-pharmacological treatment with the latter emphasizing in lifestyle changes to enhance social networks and overall social inclusivity are significant in enhancing the patient outcome. References Cuijipers, P., van Straten, A., Andersson, G. & van Oppen, P. (2008). Psychotherapy for depression in adults: A meta-analysis of comparative outcome. Journal of Consulting and Clinical Psychology, 76(6), 909-922. Dziegielewski, S.F. (2010). DSM-IV-TR in Action (2nd ed.). Hoboken: John Wiley & Sons. Halverson, J.L. (2015). Depression treatment and management. Retrieved from http://emedicine.medscape.com/article/286759-treatment#aw2aab6b6b1aa Hollon, S.D. & Ponniah, K. (2010). A review of empirically supported psychological therapies for mood disorders in adults. Depression Anxiety, 27(10), 891-932. Kendrick, T. & Peveler, R. (2010). Guidelines for the management of depression: NICE work. The British Journal of Psychiatry, 197(5), 345-347. Law, R. (2011). Interpersonal psychotherapy for depression. Advances in Psychiatric Treatment, 17(1), 23-31. Moos, R.H. (2013). List stressors, social resources, and the treatment of depression. In J. B. Kleinman (Ed.), Psychosocial aspects of depression (pp. 187-214). Hillsdale: Lawrence Erlbaum Assoc. National Collaborating Centre for Mental Health (UK). (2010). Depression: The treatment and management of depression in adults (Updated edition). Leicester: British Psychological Society. Timonen, M. (2008). Management of depression in adults. British Medical Journal, 336(435), 1-5. VicHealth. (2006). Evidence-Based mental health promotion resource. Melbourne, Vic.: Public Health Group, Victorian Government Department of Human Services. Read More