Depression

Ms. Z is a 28-year-old assistant store manager who arrives at your outpatient clinic complaining of sadness after her boyfriend of 6 months ended their relationship 1 month ago. She describes a history of failed romantic relationships, and says, “I don’t do well with breakups.” Ms. Z reports that, although she has no prior psychiatric treatment, she was urged by her employer to seek therapy. Ms. Z has arrived late to work on several occasions because of oversleeping. She also has difficulty in getting out of bed stating, “It’s difficult to walk; it’s like my legs weigh a ton.” She feels fatigued during the day despite spending over 12 hours in bed and is concerned that she might be suffering from a serious medical condition. She denies any significant changes in appetite or weight since these symptoms began.

Ms. Z reports that, although she has not missed workdays, she has difficulty concentrating and has become tearful in front of clients while worrying about not finding a significant other. She feels tremendous guilt over “not being good enough to get married,” and says that her close friends are concerned because she has been spending her weekends in bed and not answering their calls. Although during your evaluation Ms. Z appeared tearful, she brightened up when talking about her newborn nephew and her plans of visiting a college friend next summer. Ms. Z denied suicidal ideation.

The primary diagnosis would be Major Depressive Disorder, Single Episode, Mild. The differential diagnoses would be Adjustment Disorder with Depressed Mood and Dysthymic Disorder. The DSM5 codes for these diagnoses are, respectively, 296.2x and 309.28. The ICD 10 codes for these diagnoses are, respectively, F32.0 and F34.1.

Ms. Z would likely benefit from treatment with an antidepressant medication. Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed type of antidepressant, and are considered first-line treatment for major depressive disorder. SSRIs are generally well-tolerated, with the most common side effects being gastrointestinal upset, headache, and sexual dysfunction. Ms. Z’s fatigue and difficulty concentrating are consistent with symptoms of major depressive disorder, and her tearfulness and guilt suggest that she may be experiencing significant distress. SSRIs are effective in treating the symptoms of major depressive disorder, and may also help to improve Ms. Z’s sleep and energy levels.

I would recommend non-pharmacological treatment in the form of cognitive behavioral therapy (CBT). CBT has been shown to be an effective treatment for depression, and has been found to be especially effective in treating patients with a history of failed romantic relationships. In addition, CBT can help patients to learn how to cope with breakups in a healthy way.

A health promotion intervention that would be appropriate for this patient is to provide information about the signs and symptoms of depression, and to encourage the patient to seek professional help if her symptoms persist or worsen. Additionally, the patient should be encouraged to maintain healthy lifestyle habits, including a healthy diet and regular exercise, to help reduce her risk of developing depression.