Depression

CASE STUDY: Depression

Review of Mental Health/Psychiatric Symptoms

J.D. is currently being treated by his primary care provider with Zoloft 50 mg orally, daily for generalized depression.

He does have a history of seeking out a psychotherapist for treatment 3 years ago, but now is being followed by his primary care provider. His primary care began treatment with the SSRI 6 months ago.

He denied any history of mania or hypomania.

He denies any history of anxiety.

There was no personal or family history of an eating disorder, attention deficit, or hyperactivity.

He does not endorse past traumatic experiences or times when he was treated badly. He has said that he grew up very poor and raised by his mother who was a single parent.

He has never experienced impaired perceptions, no hallucinations, auditory or visual, no delusions or paranoia.

There is no evidence of thought disorder.

His thoughts are organized and logical, and judgment and insight are good.

No SI, no HI, no history of self-harm or suicide attempts.

He drinks alcohol occasionally but has never experienced withdrawal symptoms or sought services for substance use disorder.

He denies the use of other substances.

Assessment

J.D. is a 46-year-old married, white father of two school aged children. He and his husband are also partnering in a small grocery store business. He shares that the business is doing well, and his children are happy and healthy. His relationship with his husband has never been stronger.

He meets diagnostic criteria for MDD (recurrent) with current symptoms of low energy, and hypersomnia during the day and insomnia at night.

He denies anxiety symptoms.

He is feeling a little better with the Zoloft but thought he would be feeling better by now. He says the insomnia is the major reason he is here. He said that he needs his sleep to care for the kids and run the store. He explains that even though his energy level has improved, the burden of running the store is on his partner and that is not fair to him. He does not endorse hopelessness and does not have SI. He is asking about increasing the Zoloft. He explains that the PCP told him that he was on a very low dose.

He is also considering going back to the therapist for more sessions if necessary.

He states the days that he takes the children to the park increase his socialization with neighbors and increase his energy and sense of well-being. On the other hand, working in the store with the customers every day can be emotionally and physically draining because he is always trying to provide good customer service with a smile.

Diagnosis and Follow-Up

Major depressive disorder (MDD).

The plan may include obtaining electrolytes, CBC with differential, and thyroid panel to rule out organic causes of symptoms.

Schedule an appointment with the prescribing provider of the Zoloft for evaluation of response to the medication and the possibility of increasing the dose. He is interested in increasing the dose of his Zoloft, which is reasonable.

The prescribing clinician would review the expected response to SSRI, including that it takes about 4 to 6 weeks for optimal effects, and has possible adverse effects.

What is the first-line recommended treatment for mild to moderate depressive symptoms?

Using the monoamine hypothesis, how can the clinician explain the reasons for depression?

After performing an assessment for depression, what are two items that are imperative to add to the assessment when the patient is found to be depressed?

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