Assignment Task:
1. Reply from Daniela Barbeito
Depression Case
Summary of the Clinical Case
Ms. Z is a 28-year-old assistant store manager who appears sad after she had a breakup one month ago. On the subjective, she complains that she has low mood, oversleeping, fatigue despite long sleep duration, lack of concentration and that she feels guilty because she is not good enough to marry. She writes about a past of inability to adapt well to romantic breakups and her recent social withdrawal, where her friends are worried that she is secluded. Objectively, she has never missed work but has been late to the office because of oversleeping and has exhibited emotional instability with customers. In the assessment, she seemed to shed tears though she showed mood reactivity when talking about positive things, including her nephew and her travel plans. Significantly, she denies suicidal thoughts and denies any major alterations in her appetite or weight.
Primary and Differential Diagnoses:
The overall diagnosis of Ms. Z is a single episode, moderate, Major Depressive Disorder (MDD) (DSM-5: 296.22; ICD-10: F32.1). This is justified by her depressed mood, hypersomnia, fatigue, lack of concentration, excessive guilt and social/occupational impairment of more than two weeks (McGuiness et al., 2022). The diagnosis is adjustment disorder with Depressed Mood (DSM-5: 309.0; ICD-10: F43.21), which had the symptoms developed in three months after the breakup, and the symptoms are associated with a particular stressor. Persistent Depressive Disorder (Dysthymia) (DSM-5: 300.4; ICD-10: F34.1) is another difference being viewed as less probable because of the duration of her symptoms (Xiong et al., 2023). The reactivity in mood that was shown in the interview is indicative of a possible adjustment disorder, though functional impairment and constellation of symptoms are closer to MDD. Close follow up is required to ensure that symptoms persist even after the acute stressor has been eliminated.
Pharmacological Treatment:
According to APA and NICE recommendations, the selective serotonin reuptake inhibitors (SSRIs), which include sertraline or escitalopram, are the first-line pharmacological therapy of MDD (McGuinness et al., 2022). The SSRIs are chosen because of their desirable side effect profile, effectiveness and tolerability in young adults. A starting dosage of sertraline of 50mg/day would be suitable and can be increased with tolerance. It is aimed at the elimination of hypersomnia, fatigue, low mood, and concentration problems. Psychoeducation regarding the slow-moving effects of antidepressants and compliance must be used alongside pharmacotherapy in order to avoid premature discontinuation. Follow-up is necessary to control treatment response and side effects especially due to the occupational commitments and psychosocial stressors of Ms. Z.
Non-Pharmacological Treatment:
Cognitive behavioral therapy (CBT) is the type of non-pharmacological treatment that has solid evidence on decreasing depressive symptoms and relapse prevention. CBT would assist Ms. Z to define and reorganize negative automatic thoughts in areas of guilt, self-worth, and failed relationships. Moreover, behavioral stimulation techniques may encourage her to reconnect with pleasurable social activities, as they will neutralize her isolation and her lack of activity. Another possible therapy is the interpersonal therapy (IPT), as her symptoms are related to relationships, grief, role transitions, and the formation of healthier attachments are put at the center (Xiong et al., 2023). Psychotherapy is advised as either a standalone treatment in mild depression or as a combination with medication in severe and moderate depression cases. Ms. Z is reactive and has strengths including future oriented thinking which can make her respond positively to therapy.
Health Promotion Intervention:
The correct health promotion intervention that would be used in the work with Ms. Z is lifestyle modification counseling which would include sleep hygiene, physical exercise, and social connectedness (McGuinness et al., 2022). As is known, regular exercises (e.g. walking or yoga) may have a positive effect on moods and fatigue. Her hypersomnia would be treated with sleep hygiene, which would mean that she regularly gets up and not spend too much time in bed. Changing the order of friends and relatives can help to cure loneliness and to give emotional support. Resilience can be developed by means of the psychoeducation in relation to the identification of the initial symptoms of a depression and the ability to coping with stressful situations in a healthy way (Xiong et al., 2023). These interventions are consistent with the idea of the holistic approach and provide Ms. Z with an opportunity to be a key participant of her healing. Need Assignment Help?
2. Reply from Agar D Joseph
Discussion
Ms. Z is a 28-year-old assistant store manager experiencing sadness, fatigue, hypersomnia, difficulty concentrating, excessive guilt, and social withdrawal following a recent breakup. She reports feeling that she struggles significantly with breakups, spending over 12 hours in bed daily, and experiencing a sensation of heaviness in her legs that makes it challenging to walk.
She denies any changes in appetite or weight and has no prior psychiatric history. Although she has not missed work, she has been arriving late due to oversleeping.
During the evaluation, Ms. Z appeared tearful but showed some emotional reactivity when discussing positive future plans and family relationships, indicating that her mood reactivity is somewhat preserved. She denied any suicidal ideation but expressed significant psychosocial distress.
The primary diagnosis is Major Depressive Disorder (MDD), single episode, moderate severity (DSM-5-TR 296.22; ICD-10 F32.1), as her symptoms of persistent sadness, hypersomnia, fatigue, impaired concentration, guilt, and functional impairment align with this diagnosis. A differential diagnosis to consider is Persistent Depressive Disorder (Dysthymia) (DSM-5-TR 300.4; ICD-10 F34.1), based on her difficulty coping with failed relationships; however, her symptoms have not been present long enough to meet the two-year criterion.
Another differential diagnosis is adjustment disorder with depressed mood (DSM-5-TR 309.0; ICD-10 F43.21), since her symptoms are temporally linked to the breakup. Nevertheless, the severity of her symptoms and functional impairment suggest an episode of MDD rather than a temporary adjustment response.
For pharmacological treatment, an SSRI, such as sertraline, would be an appropriate first-line therapy. Clinical guidelines recommend SSRIs as initial treatment for MDD due to their efficacy, favorable safety profile, and tolerability, especially in young adults without prior psychiatric treatment (American Psychiatric Association, 2023; Cipriani et al., 2023). Sertraline is FDA approved and has a relatively low risk of drug interactions, making it suitable for improving mood, energy, and concentration.
Non-pharmacological treatments should include Cognitive Behavioral Therapy (CBT), which is strongly endorsed by guidelines as an evidence-based intervention for MDD. CBT addresses maladaptive thought patterns, such as guilt and feelings of inadequacy, helping patients develop coping skills and resilience (Cuijpers et al., 2021). Given that Ms. Z's symptoms are closely related to interpersonal stressors and negative self-appraisal, psychotherapy may be especially beneficial for her.
Additionally, a health promotion intervention would involve encouraging structured physical activity, such as aerobic exercise three to five times per week, which has been shown to improve mood, reduce fatigue, and promote better sleep regulation in individuals with depression (Schuch et al., 2022). Reinforcing good sleep hygiene and encouraging engagement with social support, such as reconnecting with friends, would also aid in her recovery and help combat feelings of isolation.