Depression of Sandy B

One of the most common mental health conditions suffered by patients is that of depression. In this hypothetical scenario, patient Sandy B is a woman who has been given a diagnosis of major depressive disorder. Major depressive disorder affects approximately 13 to 14 million American adults on an annual basis (DeRubeis, Siegle, & Hollon 2008). As well as being personally stressful, it can have a profoundly debilitating effect on a person’s ability to be economically productive. It affects a patient’s family as well, due to the sufferer’s inability to complete the acts of daily life or to participate in social functioning. It also poses a high risk for the patient in regards to suicide.
Sandy B is a 40-year-old woman, recently divorced, and living alone. Although major depressive disorder is defined by a significant inhibition in the ability to engage in daily life functions, Sandy B reports that she is able to go to her job as an accountant on a daily basis. Still, she reports that she is unable to socialize, spends much of her non-working hours sleeping, and finds it difficult to concentrate while at work due to her sense of overwhelming despair (Reynolds & Kamphaus 2013). Although she says she is not actively suicidal because she has strong religious beliefs which prohibit suicide, she says she has no enjoyment of her life.
Because of obstacles to soliciting treatment for therapy, many patients suffering from depression solicit assistance from general practitioners in the form of antidepressants. But evidence-based research indicates that a combination of therapy and antidepressants is more effective than psychopharmacology alone (DeRubeis et al. 2013). Like some patients, Sandy B states that she does not merely want to be treated with pills and wants to get to the heart of what has caused her disorder. She admits to struggling with minor bouts of depression in the past, although she says her current depressive incident stems from the termination of her marriage with her husband, leaving her with a sense of feeling like a failure.
Despite its commonness, depression can be extremely resistant to treatment. Depressive disorders have been found to have a strong heritable component but environmental stressors can also trigger its manifestation (DeRubeis et al. 2013). One of the most effective non-pharmacological interventions has been found to be cognitive behavioral therapy (CBT). CBT, unlike psychodynamic therapy, is goal-directed and has a finite number of sessions in most instances, including regular emotional homework for the client to complete to facilitate the treatment process. Thus, given the limited insurance coverage in many instances for depression (one of the concerns articulated by Sandy B, as she worked for a small, private accounting firm that offered a very limited health insurance plan), CBT is often one of the more attractive therapeutic modalities for treating depression.
CBT has also been found to be one of the more effective techniques in treating depression. CBT focuses on identifying unproductive and irrational thought patterns and behaviors, such as “I am worthless” and “no one will ever love me,” and replacing them with more effective thought processes (DeRubeis et al. 2013). “This ‘cognitive model’ posits that when maladaptive thinking is corrected, both acute distress and the risk for subsequent symptom return will be reduced” and has been found to be more effective than the use of antidepressants alone (DeRubeis et al. 2013, par.11). Patients have successfully experienced relief from CBT even in the absence of concurrent use of antidepressants, although the two therapeutic modalities are not mutually exclusive. In the end, Sandy B elected to try CBT to treat her depression. She did state, however, that if she felt that the treatment was not effective, she would be willing to try an antidepressant in the future. She also indicated a willingness to alert her therapist if her depression intensified and she was beginning to experience suicidal ideation.


References
DeRubeis, R. J., Siegle, G. J., & Hollon, S. D. (2008). Cognitive therapy vs. medications for
depression: Treatment outcomes and neural mechanisms. Nature Reviews. Neuroscience, 9(10), 788–796. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2748674/
Reynolds, C. & Kamphaus, R. (2013). Major Depressive Disorder 296.xx (F32.x and F33.x).
Pearson. Retrieved from: https://images.pearsonclinical.com/images/assets/basc- 3/basc3resources/DSM5_DiagnosticCriteria_MajorDepressiveDisorder.pdf