Case Discussion on Depression: A 28-year-old female

Posted: June 6th, 2021

IInstructions: Case Discussion on Depression:

A 28-year-old female presents to your office stating that she is troubled by headaches and fatigue. She says that she always feels tired and can’t sleep well, often waking up early if she gets to sleep at all. She describes her headaches as dull, aching, and generalized. These symptoms began about three weeks ago and have been getting worse. She reports a lack of interest in her usual activities, even the ones that she used to enjoy. She also reports that she is missing work due to fatigue and inability to concentrate. Although both her children are in school, she is concerned that she is “losing them”. She is worried that she might have “something bad” because she has difficulty concentrating and is having frequent crying spells. She reports a loss of appetite, with a weight loss of 10 pounds in the last month.

The patient has no significant past medical or psychiatric history and takes no regular medications. However, she takes ibuprofen for headaches. She denies using alcohol or drugs. The patient is married, with two elementary school-age children.

Summarize the clinical case.
Create a list of the patient’s problems and prioritize them.
Which diagnosis should be considered
What is your rationale for the diagnosis
What differential diagnosis should be considered
What test or screening tools should be considered to help identify the correct diagnosis
What treatment would you prescribe and what is the rationale (consider psychopharmacology, diagnostics tests, referrals, psychotherapy, psychoeducation)
What standard guidelines would you use to assess or treat this patient Responses need to address all components of the question, demonstrate critical thinking and analysis and include peer-reviewed journal evidence to support the student’s position.
Submission Instructions
Your initial post should be at least 500 words,formatted and cited in current APA style with support from at least 2 evidence-based sources.
You should respond to at least two of your peers
All replies must be constructive and use literature where possible.
Please post your initial response by 11:59 PM ET Wednesday, and comment on the posts of two classmates by 11:59 PM ET Sunday.
Posting on a minimum of 3 different days, for example: Wednesday, Friday, and Sunday.
Late work policies, expectations regarding proper citations, acceptable means of responding to peer feedback, and other expectations are at the discretion of the instructor. Please review the rubric to ensure that your response meets criteria. Be sure to validate your opinions and ideas with citations and references in APA format
Always construct your response in a word processing program like Word. Check for grammar, spelling, and mechanical errors.
There are no “make-ups” for not posting to the Weekly Discussions
Avoid postings that are limited to ‘I agree’ or ‘great idea’, etc. If you agree (or disagree) with a posting, then say why you agree (or disagree) by supporting your statement with concepts from the readings or by bringing in a related example or experience
Address the questions as much as possible
Use proper etiquette (address your peer by name, use professional language, etc.). Antidepressant Agents.

A 28-year-old female patient presents with headaches, fatigue, insomnia, lack of interest in usual activities, difficulty concentrating, frequent crying spells, loss of appetite and 10 lbs weight loss over the past month. She is concerned about “having something bad” and worries she is “losing” her children due to her symptoms. Her symptoms began 3 weeks ago and have been worsening. She has no significant medical history and does not take any medications regularly aside from ibuprofen for headaches.
The patient’s primary problems seem to be:
Insomnia
Fatigue
Loss of interest/anhedonia
Difficulty concentrating
Depressed mood
Changes in appetite and weight
The diagnosis that should be considered based on the presentation of symptoms is major depressive disorder (MDD). The diagnostic criteria for MDD fit her symptoms of depressed mood, anhedonia, insomnia, fatigue, difficulty concentrating, and changes in appetite/weight (American Psychiatric Association, 2013).
The rationale for this diagnosis is that the patient is experiencing at least 5 of the 9 symptoms of depression as outlined in the DSM-5, including the two core symptoms of depressed mood and anhedonia, and her symptoms have been present for over 2 weeks (APA, 2013). Her symptoms are also causing clinically significant distress and impairment in her social and occupational functioning.
Some potential differential diagnoses to consider include:
Generalized anxiety disorder: could explain some of the physical symptoms like headaches and fatigue, but does not fully account for the depressed mood and anhedonia.
Adjustment disorder with depressed mood: her stressors (work, family responsibilities) do not seem severe enough to warrant this diagnosis on their own.
Medical conditions like hypothyroidism: however, her symptoms are predominantly psychological in nature.
Initial screening tools that could help assess severity and provide a baseline for treatment include the Patient Health Questionnaire (PHQ-9; Kroenke et al., 2001) and the Beck Depression Inventory (BDI; Beck et al., 1961). Further diagnostic clarification could involve a physical exam and basic lab tests to rule out medical causes for her symptoms.
For treatment, I would recommend starting an antidepressant medication along with psychotherapy. Research supports the use of SSRIs as first-line treatment for MDD due to their effectiveness and tolerability (National Institute for Health and Care Excellence, 2009). Specifically, sertraline or escitalopram may be good initial options given their favorable side effect profiles (Cipriani et al., 2018). Psychotherapy, particularly cognitive-behavioral therapy (CBT), has also been shown to be an effective treatment either alone or in conjunction with antidepressants for MDD (Cuijpers et al., 2013).
I would provide psychoeducation about depression, its biological basis, and the importance of adherence to treatment. Referral to a licensed therapist for 8-16 sessions of CBT could help her learn coping strategies. Close monitoring of her symptoms and side effects is also recommended as per guidelines from the Texas Medication Algorithm Project and the American Psychiatric Association.
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Case Discussion on Depression:
A 28-year-old female presents to your office stating that she is troubled by headaches and fatigue. She says that she always feels tired and can’t sleep well, often waking up early if she gets to sleep at all. She describes her headaches as dull, aching, and generalized. These symptoms began about three weeks ago and have been getting worse. She reports a lack of interest in her usual activities, even the ones that she used to enjoy. She also reports that she is missing work due to fatigue and inability to concentrate. Although both her children are in school, she is concerned that she is “losing them”. She is worried that she might have “something bad” because she has difficulty concentrating and is having frequent crying spells. She reports a loss of appetite, with a weight loss of 10 pounds in the last month.
The patient has no significant past medical or psychiatric history and takes no regular medications. However, she takes ibuprofen for headaches. She denies using alcohol or drugs. The patient is married, with two elementary school-age children.
Summarize the clinical case.
As summarized previously, a 28-year-old female patient presents with headaches, fatigue, insomnia, lack of interest in usual activities, difficulty concentrating, frequent crying spells, loss of appetite and 10 lbs weight loss over the past month. She is concerned about “having something bad” and worries she is “losing” her children due to her symptoms. Her symptoms began 3 weeks ago and have been worsening. She has no significant medical history and does not take any medications regularly aside from ibuprofen for headaches.
Create a list of the patient’s problems and prioritize them.
The patient’s primary problems seem to be:
Insomnia
Fatigue
Loss of interest/anhedonia
Difficulty concentrating
Depressed mood
Changes in appetite and weight
Which diagnosis should be considered
The diagnosis that should be considered based on the presentation of symptoms is major depressive disorder (MDD).
What is your rationale for the diagnosis
The rationale for this diagnosis is that the patient is experiencing at least 5 of the 9 symptoms of depression as outlined in the DSM-5, including the two core symptoms of depressed mood and anhedonia, and her symptoms have been present for over 2 weeks (APA, 2013). Her symptoms are also causing clinically significant distress and impairment in her social and occupational functioning.
What differential diagnosis should be considered
Some potential differential diagnoses to consider include:
Generalized anxiety disorder: could explain some of the physical symptoms like headaches and fatigue, but does not fully account for the depressed mood and anhedonia.
Adjustment disorder with depressed mood: her stressors (work, family responsibilities) do not seem severe enough to warrant this diagnosis on their own.
Medical conditions like hypothyroidism: however, her symptoms are predominantly psychological in nature.
What test or screening tools should be considered to help identify the correct diagnosis
Initial screening tools that could help assess severity and provide a baseline for treatment include the Patient Health Questionnaire (PHQ-9; Kroenke et al., 2001) and the Beck Depression Inventory (BDI; Beck et al., 1961). Further diagnostic clarification could involve a physical exam and basic lab tests to rule out medical causes for her symptoms.
What treatment would you prescribe and what is the rationale (consider psychopharmacology, diagnostics tests, referrals, psychotherapy, psychoeducation)
For treatment, I would recommend starting an antidepressant medication along with psychotherapy. Specifically, sertraline or escitalopram may be good initial options given their favorable side effect profiles (Cipriani et al., 2018). Psychotherapy, particularly cognitive-behavioral therapy (CBT), has also been shown to be an effective treatment either alone or in conjunction with antidepressants for MDD (Cuijpers et al., 2013). I would provide psychoeducation about depression, its biological basis, and the importance of adherence to treatment. Referral to a licensed therapist for 8-16 sessions of CBT could help her learn coping strategies. Close monitoring of her symptoms and side effects is also recommended as per guidelines from the Texas Medication Algorithm Project and the American Psychiatric Association.
What standard guidelines would you use to assess or treat this patient Responses need to address all components of the question, demonstrate critical thinking and analysis and include peer-reviewed journal evidence to support the student’s position.
I would follow guidelines from the National Institute for Health and Care Excellence (2009) and the American Psychiatric Association (2013) in assessing and treating this patient. As noted above, initial screening with the PHQ-9 or BDI could help establish a baseline severity (Kroenke et al., 2001; Beck et al., 1961). SSRIs are recommended as first-line treatment for MDD due to their effectiveness and tolerability (NICE, 2009). CBT either alone or combined with antidepressants is also supported as an evidence-based treatment for depression according to meta-analyses (Cuijpers et al., 2013). Close monitoring of symptoms and side effects would follow algorithms from the Texas Medication Algorithm Project and safety guidelines from the APA (2013).

References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of general psychiatry, 4(6), 561–571. https://doi.org/10.1001/archpsyc.1961.01710120031004
Cipriani, A., Furukawa, T. A., Salanti, G., Chaimani, A., Atkinson, L. Z., Ogawa, Y., Leucht, S., Ruhe, H. G., Turner, E. H., Higgins, J. P., Egger, M., Takeshima, N., Hayasaka, Y., Imai, H., Shinohara, K., Tajika, A., Ioannidis, J. P., & Geddes, J. R. (2018). Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. The Lancet (British edition), 391(10128), 1357–1366. https://doi.org/10.1016/S0140-6736(17)32802-7
Cuijpers, P., Berking, M., Andersson, G., Quigley, L., Kleiboer, A., & Dobson, K. S. (2013). A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments. The Canadian Journal of Psychiatry, 58(7), 376–385. https://doi.org/10.1177/070674371305800702
Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of general internal medicine, 16(9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
National Institute for Health and Care Excellence (2009). Depression in adults: recognition and management. Clinical guideline [CG90]. London.