Major depressive disorder in a case study of Tina

Tina's Story

There is a considerable of variation in the occurrence of MDD among U.S. youth as reported by research studies on depression in adolescents. Fleming and Offord (1990) conducted a critical review and found that currently the occurrence depression ranges from .4-5.7%, with a mean occurrence of 3.6%. Similarly another study in which the sample were high school students (between the ages of 14-18 years), the results revealed that the depression rate during the lifetime among students was 24% (Lewinsohn, Hops, Roberts, Seeley, & Andrews, 1993). This result is similar to the rates of lifetime occurrence of MDD among old adolescents (15-24 years) and young adults revealed by the National Comorbidity Study (25.2%; Kessler & Walters, 1998). Also the findings from the "Methods for the Epidemiology Child and Adolescent Mental Disorders" study (MECA; Shaffer, 1996) established that the pervasiveness of major depression was 3.1% as reported by parents while it was 4.8% as reported by child.

The current paper is based on the case study of Tina who is a prey to MDD after breakup with her husband who left her for another woman four weeks back. The author will discuss the Major Depressive Disorder, its prevalence, consequences, diagnosis and treatment.

Symptoms of Depression

Depression is a widespread mood disorder affecting people of all ages, genders, cultures and backgrounds (World Health Organization [WHO], 2007). Depression has both been described as a pathological feeling of sadness (Sadock & Sadock, 2003) and "a dysphasia that can vary in severity from a fluctuation in normal mood to an extreme feeling of sadness, pessimism, and despondency" (American Psychological Association [APA], 2007, p. 269). While the experience of being human includes a wide array of emotions ranging from elation to despair, in mood disorders, in particular, "the sense of control is lost, and there is a subjective experience of great distress" (Sadock & Sadock, 2003, p. 534). This definition of depression is in accordance with Tina's condition after her husband left her as she is sad. She has no control on herself, her sleep schedule and she is not going to her duty.

Depression has become a global problem as well as the main reason that leads to disability and mortality (Murray & Lopez, 1997). It is a known factor that Major Dipressive Disorder (MDD) is a problem that frequently occurs among adolescents and also that its occurrence among younger birth cohorts is greater than before during the past decade. Additionally, there is a substantial increment in the risk of it first commencement post the age of 14, while the middle and late years of adolescent (between 15-25 years of age) are the peak periods during which there is risk of development of new depressive symptomatology (Kessler, 2003, 2005). Tina is 22 years old and is prone to MDD.

There is evidence from a vast body of research confirming that there is a difference amongst males and females as regards the rates of prevalence of MDD occurring during the peak beginning years. There is consistent reports of higher rates of major depression among adolescent and adult females (2-2.5 fold as compared to males) not just in United States but also internationally (Hankin, 1998), which suggests that there is a difference between boys and girls as regards the transition from childhood to adolescence which is a more difficult period for girls than boys (Twenge & Nolen-Hoeksema, 2002).

As compared to males adolescent females are at more risk of MDD (Twenge & Nolen-Hoeksema, 2002). Augmented levels of self reported depression have been seen among girls as compared to boys. Ethnicity also is the reason of different level of depression among males and females for instance a study compared the depression rates among African-American and Causian young males and females it was found that the self reported levels of depressive symptomatology was higher among Latino girls (31.2%)

Psychological/Psychiatric Definition

"Depression n. 1. DYSPHORIA that can vary in severity from a fluctuation in normal mood to an extreme feeling of sadness, pessimism, and despondency" (American Psychological Association [APA], 2007, p. 269).

In the United States, the diagnosis of a mood disorder is based on the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IVTR)(American Psychiatric Association [APA], 2000). The DSM-IV-TR (2000) states that all of the mood disorders share a disturbance in mood as their principal characteristic and includes the diagnoses Major Depressive Disorder (MDD), Dysthymic Disorder, and Bipolar Disorder (APA, 2000). For MDD, the DSM-IV-TR's diagnostic criteria (DSMIV-TR diagnostic code 296.2x) include: experiencing a depressed mood for a period of two consecutive weeks or more; the loss of interest or pleasure in activities; feelings of guilt or low self-worth; disturbed sleep or appetite; low energy; poor concentration; and suicidal ideation, plans, or attempts (APA, 2000).

As is evident from Tina's story, she has been found passing most of her time in her apartment not going to work and not visiting gym though previously she has been a cheerful and active girl and used to go to gym three days a week.

Effects of Depression

"The more [depressive] episodes you have, the more likely you are to have more episodes, and in general the episodes, over a lifetime, get worse and closer together" (Solomon, 2001, p. 56).

Depression's leading to disability and impairment Depression is responsible for causing tremendous suffering. As symptoms of depression become either acute and/or chronic, they can lead to significant impairments in a person's ability to function in multiple domains of their lives that may equal, or even exceed, those of patients with chronic medical illnesses. Depression has also been associated with an increased risk of both substance abuse and suicide (Substance Abuse and Mental Health Services Administration, 2005; World Health Organization [WHO], 2007). In addition, depression adds to health care costs, and increases overall productivity losses. Depressed persons may experience generalized psychomotor retardation and have difficulty concentrating and thinking clearly (American Psychiatric Association [APA], 2000; Sadock & Sadock, 2003) Depression has also been associated with increased risks for heart attacks and has been determined to be a complicating factor in stroke, diabetes, and cancer (National Institute of Mental Health (NIMH), 1999).

With loss of energy and diminished interest in the world around them, persons suffering from depression often experience impairments in interpersonal relationships, as well as in functioning in their occupation; spouses increasingly withdraw from their partners; and parents, sadly, become increasingly unavailable to their children. In fact, The World Health Organization has recently implicated depression as the leading cause of disability worldwide (World Health Organization [WHO], 2007).

Depression and Sociality

Tragically, the suffering from depression can lead to suicide, a cause of death associated with the loss of about 850,000 lives annually worldwide (World Health Organization [WHO], 2007). Approximately 30,000 of those deaths occur in the United States (National Institute of Mental Health (NIMH), 1999). Currently, suicide is ranked as the ninth most common cause of death in the U.S. (Venes, 2007). It is important to note that two-thirds of all depressed patients have had the experience of contemplating suicide, with 10 to 15% of them completing the act (Sadock & Sadock, 2003). Additionally, 45-70% of completed suicides have been found to have experienced a mood disorder (Sadock & Sadock, 2003). In the United States, estimates of completed suicides for patients with mood disorders is 400 per 100,000 for male patients and 180 per 100,000 for female patients (Sadock & Sadock, 2003).

In Tina's case we see that she thinks of suicide but she does not feel that she is at a point where she must decide for suicide. Yet, as she is hopeless because of her broken relationship with her husband Joe and she does think that she will not find a good relationship so there is a possibility of her deciding suicide if not provided with proper treatment.

The Importance of Accurate Diagnosis

Because depression causes such a tremendous degree of pain and suffering, a prompt and accurate diagnosis is essential for the patient to receive optimal clinical care. Researchers have indicated that under or over-diagnosis of depression is often a detriment to the type and timing of treatment received, as well as the utilization and costs of additional services (Eaton, Neufeld, Chen, & Cai, 2000; Tiemens, VonKorff, & Lin, 1999). In addition, because depression presents a significantly increased risk for suicidality clinicians need accurate tools to evaluate for suicidality, both for the protection of the patient and to reduce the clinician's liability (American Psychiatric Association [APA], 2000; Sadock & Sadock, 2003).

Unstructured Diagnostic Interviews

The American Psychological Association describes an unstructured interview as "an interview that imposes minimal structure by asking open ended (rather than set) questions and allowing the interviewee to steer the discussion into areas of his or her choosing" (APA, 2007, p. 970). Considered "diagnosis as usual" the unstructured clinical interview is currently considered the standard of practice for the assessment of psychopathology (Miller, 2001; Zimmerman, 2003;).

Structured Diagnostic Interviews

The American Psychological Association describes a structured interview as "an interview consisting of a predetermined set of questions or topics" (American Psychological Association [APA], 2007, p. 901). Used extensively in research settings, numerous studies have indicated that structured interviews are often more through, accurate and reliable than unstructured interviews in determining clinical diagnoses. Several studies examining diagnostic accuracy found that when patients were simultaneously diagnosed with both structured and unstructured interviews, the structured interviews both revealed more co-morbidity and, missed fewer diagnoses (Hilsenroth & Segal, 2004)

Screening Instruments

In addition to the interviews and self reported measures there are other screening instruments. Screening measures generally do not include the more extensive diagnostic criteria found in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR). Criteria frequently includes the length of time the respondent has experienced their symptoms, the degree of their overall impairment, and the potential presence of any co-morbid psychiatric or physiologic disorders. As there are multiple disorders that have symptoms that are common to depression (e.g. Schizophrenia, Bi-Polar Disorder, Substance Dependence, and Schizoid Personality Disorder, as well as hypothyroidism, and pancreatic cancer), without additional DSM-IV symptom criteria being ruled out, the symptoms and severity of depression alone are not sufficient to provide an accurate diagnosis of Major Depressive Disorder (Sharp & Lipsky, 2002).

Treatment

In addition to medication there are many types of treatments such as counselling, stress management courses, group therapy, exercise. In my opinion Tina need medication in addition to counseling. Because she can't sleep more than four times at a time that is why she need medication. Also she feels lonely and there is no one with whom she can share her grief there is a need of group therapy involving some of her friends of colleagues.