Problem
Mr. Jones, a 19-year-old single Caucasian male, recently homeless, and unemployed (supported by extended family), enrolled in a vocational training program and walked into the ED requesting a medication refill.
On evaluation, the patient was found to be severely depressed, and apathetic. His labs and EKG were within normal limits. He was admitted for safety and stabilization.
During inpatient evaluation, the patient reported that his mother died of cancer 4 years prior to presentation when he was 15 years old. He reported being by his mother in the hospital when she died. He blamed himself for his mother's death. Reports that he feels like his soul died when she did.
Since his mother's death, he has been yearning for her, longing to be with her, and has had frequent crying spells. "I just can't believe that she is really gone. I feel like it's all a bad dream and I am going to wake up and see her." He reported repeated nightmares in which his mother calls him, but he cannot answer. He states that he usually wakes up from such dreams drenched in sweat. The patient also started smoking marijuana which prompted the rest of his family to abandon him, further hollowing his support structure.
He reported difficulty with sleep (three hours of sleep at night) and loss of interest in playing his saxophone and trumpet and playing sports (which he used to love). He reported low energy and poor appetite for about five months. He denied suicidal or homicidal ideation.
The patient was overwhelmed by his symptoms and had to be placed on medical leave from his professional training program. Collateral information from his training program revealed that the patient's "mental health was interfering with his work."
His Beck's Depression Inventory score was 19, and his Hamilton Depression Rating Scale (HAM-D) score was 21.
a) What do you think the diagnosis is for Mr. Jones?
b) Connect his presenting symptoms to a diagnosis in the DSM-5TR.
c) Does this disorder require medication?