Major Depressive Disorder Essay, Research Paper
Mrs. M shows some signs of major depressive disorder. Mrs. M has been experiencing intense sadness without any real cause which is causing her to feel overwhelmed and perplexed. The most recent incidence was when a dish fell on the floor and broke which led her to sit on the floor, hit the floor with her fist, and cry. She stopped crying when she became startled at the fact that her hand was bleeding from pounding the broken glass. She then went into her car to go to work, when she began to cry again for no reason. She eventually called in sick to work. Mrs. M’s intense sadness, the above being one example, is a symptom of major depressive disorder.
Mrs. M has also been experiencing melancholic features such as a loss of interest in activities that are usually pleasurable. She has withdrawn herself from activities with her children, leaving the job to her husband. She has also withdrawn from her social contacts at work, no longer eating with her colleagues, but being alone as often as she can. Her usual close to infallible work performance has decreased having several mistakes. Mrs. M’s lack of motivation and companionship are also signs of major depressive disorder. Mrs. M has also been under some stress at work within the past week. Her boss has become fairly demanding and short with her. In addition, Mrs. M has picked up several new responsibilities from a former paralegal. All of these stressors could have triggered the depression.
To further investigate my hypothesis, I questioned Mrs. M on her physical well being during the past four to six weeks. Mrs. M said that she has lost ten to fifteen pounds and seems to be tired all the time. She was confused as to why she was always tired because she was getting a lot more sleep than usual. Mrs. M may be suffering from hypersomnia, which is also a symptom of major depression.
I was very curious about the comment made about wanting to “run away” or “get away from it all.” When I questioned her about this, Mrs. M stated that she was ashamed of feeling sad all the time and is frustrated with her poor work performance. She gets distracted very easily at work and her constant desire to go to sleep does not help. She wants to go away where she can be by herself and not be a negative influence or burden on anyone else’s life. She is determined that she has ruined the lives of her children and her husband. Although she wants very much to return to her “old self,” she feels that this is impossible.
To further prove my hypothesis I asked Mrs. M about her family history of mental illness since mood disorders greatly involves genetics. Mrs. M stated that her mother was often on antidepressants when she was a child. She often heard her parents talking about it. This is a very important piece of information. In families in which one parent has a mood disorder, approximately 30% of the children are at risk of developing a disorder.
Mrs. M has been experiencing seven of the nine diagnostic features of a major depressive episode. Her symptoms are not part of a mixed episode and are not attributed to a medical condition, use of a substance, or bereavement. The symptoms are causing significant distress and impairment. Because of all of these symptoms, I feel confident that my hypothesis is correct in diagnosing Mrs. M with major depressive disorder.
There are many etiologies for this disorder. The catecholamine hypothesis states that a relative shortage of norepinephrine causes depression. Clinical evidence suggested that people who take certain antihypertensive medications become depressed, presumably because the drug depletes the levels or norepinephrine and other catecholamines. Another hypothesis is the indolamine hypothesis, which states that a deficiency of serotonin contributes to the behavioral symptoms of depression. The processes that cause a deficiency of serotonin are thought to be similar to those that cause norepinephrine deficits.
In the psychodynamic theory, depression is occurs if their parents failed to provide them with a stable and secure relationship when they were children. Mrs. M seems to have a good relationship with her mother now from the way she talks about her, but she could have been neglected to an extent as a child because of the mother’s depression. The behavioral theory of depression is due to reduction of positive reinforcement. According to this view, depressed people withdraw from life because they no longer have incentives to be active. Mrs. M’s boss had been scolding her for the past week, probably because he was under stress of his own, rather then giving her positive comments about her work, especially because she had taken on some new responsibilities. This may be the reason for her lack of motivation in the workplace as well as her depression.
In the cognitively based theory, serious mood changes can result from events in our lives or from our perceptions of events. The dysfunctional attitudes of the depressed person causes them to assume that they are worthless and helpless and their efforts are doomed to fail. They distort any experience, even a positive one, so that it fits in with this generalized belief. As a consequence of these cognitive distortions, depressed individuals experience low feelings of well-being, energy, desire to be with others, and interest in the environment. These phenomena contribute to their depressed affect.
I would use several forms of treatment for Mrs. M because I think that each theory has its correct points. I would put Mrs. M on SSRI’s. I think that this medication is very affective because not only does it have less side affects then the other antidepressants, it also has positive affects on symptoms other then the depression. Clients that take SSRI”s, Prozac especially, report that they are less sensitive to criticism and fear of rejection, while also feeling higher levels of self-esteem and ability to experience pleasure.
I would also require that Mrs. M undergo a combination of cognitive and behavioral therapy. Depressed clients often set unrealistic goals and then are unable to implement behaviors to reach these goals. I would give Mrs. M regular homework assignments that help her make gradual behavioral changes and that increase the probability of successful performance. I would also reward her every time Mrs. M initiates social activity. The reward can be anything from positive statements or a special treat that she likes.
Cognitive based therapy would also be effective in Mrs. M’s case. This will involve a short-term structured approach that focuses on Mrs. M’s negative thoughts and includes suggestions for activities that will improve Mrs. M’s daily life. This technique involves an active collaboration between Mrs. M and myself and is oriented toward current problems and their resolutions. The cognitive approach involves didactic work, cognitive restructuring, and behavioral techniques. In these three steps, I will attempt to break down the maladaptive thinking patterns that underlie the depressed individual’s negative emotions, such as Mrs. M’s feelings that she has ruined the lives of her children and her husband.
I think that Mrs. M’s prognosis is positive. Mrs. M has never mentioned any thoughts of suicide or harming herself in any way. She is also aware that the things she is feeling are not healthy nor are they normal. She has a strong desire to get back to her “old self” and is open to any form of treatment that I can provide for her. Mrs. M has a family and friends which will make cognitive and behavioral therapy much easier because she already has some social contacts. I think that Mrs. M’s major depression can be cured with medication, cognitive and behavioral therapy, and time.