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Case Study: Understanding Depression in a Patient
You have have a new 28-year-old graduate student pursuing a master’s degree in environmental science as a patient. She reports that over the past three months, she has been experiencing persistent feelings of sadness and a lack of interest in her studies and hobbies, which previously brought her joy. She reports difficulty concentrating, low energy levels, and feelings of worthlessness. Jane has also been withdrawing from her friends and family, missing social gatherings, and spending most of her time alone in her apartment.
Her sleep patterns have become irregular—she struggles to fall asleep at night but frequently oversleeps in the morning, causing her to miss important classes and deadlines. Her appetite has diminished, leading to noticeable weight loss. She acknowledges fleeting thoughts of hopelessness but denies any immediate plans to harm herself. Despite this, she feels overwhelmed and believes she is “failing at life.”
She recently visited her primary care physician, who referred her to a mental health professional. After an initial assessment, Jane was diagnosed with Major Depressive Disorder (MDD). She has been prescribed antidepressant medication and encouraged to attend weekly therapy sessions. However, she is hesitant about taking medication due to concerns about side effects and feels skeptical about whether therapy will truly help her.
Symptoms and Diagnosis:
What symptoms of depression does Jane exhibit, and how do they align with the diagnostic criteria for Major Depressive Disorder (MDD)?
How might her symptoms affect her daily functioning and relationships?
Stigma and Barriers:
Why do you think Jane is hesitant to take antidepressant medication or commit to therapy?
What role might stigma or misinformation play in her reluctance?
Treatment and Support:
What is the first line treatment with someone living with depression. What are some potential benefits of combining medication and therapy in treating depression. What education would the nurse practitioner need to provide to the patient.
What non-medical strategies could be useful to help manage her depression (e.g., lifestyle changes, support systems)?
Sample Answer
Symptoms and Diagnosis
What symptoms of depression does Jane exhibit, and how do they align with the diagnostic criteria for Major Depressive Disorder (MDD)?
Jane exhibits several classic symptoms of depression that align well with the diagnostic criteria for Major Depressive Disorder (MDD) as outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). For an MDD diagnosis, an individual must experience five or more symptoms during the same 2-week period, and at least one of the symptoms must be (1) depressed mood or (2) loss of interest or pleasure.
Here’s how Jane’s symptoms align:
- Depressed Mood Most of the Day, Nearly Every Day: Jane reports “persistent feelings of sadness.” This is a core criterion.
- Markedly Diminished Interest or Pleasure (Anhedonia): She reports a “lack of interest in her studies and hobbies, which previously brought her joy.” This is the other core criterion.
- Significant Weight Loss or Decrease in Appetite: Her “appetite has diminished, leading to noticeable weight loss.”
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