Moderate Depression Diagnosis and Treatment Planning

Introduction and Initial Assessment

The patient is a 37-year-old male who presented with symptoms of depression. Using the Beck's Depression Inventory, the patient scored 23, classifying his diagnosis as moderate depression. The initial clinic visit involved gathering information to examine his current mental state, current symptoms, biographical history, and family history (Clark et al., 2017). This information led to the identification and formulation of the relevant biological, social, and psychological factors affecting his mood. The evolution of his strategies to regulate his mood was also considered during the diagnostic process. Assessment of his mental state was accomplished by examining the consistency of themes in the information acquired — including pessimism, self-harm ideation, hopelessness, and an absence of positive thoughts or plans (Park & Zarate, 2019). Beck's Depression Scale determined the severity of the depression diagnosis based on symptoms presented during the intake visit.

Diagnostic Framework: Causes of Depression

The causes of depression are classified into three categories: precipitating, perpetuating, and predisposing causes. Precipitating causes are the immediate instigators of an individual's distress. These include psychological stressors arising from an absence of positive emotion, as well as social stressors emerging from work challenges and significant changes in a person's living and social conditions. Physical stressors — such as disease and infection — are also considered precipitating causes (Lumen Learning Abnormal Psychology, 2021). The precipitating causes relevant to this patient's diagnosis include his exposure to multiple life stressors across several domains.

Perpetuating causes worsen the patient's current condition and sustain depression over time. Symptoms associated with perpetuating causes include physical inactivity, social distress, psychological distress, emotional distress, and disturbed sleeping patterns. Predisposing causes are typically indicated by the patient's biographical history and may reflect a particular worldview or set of beliefs formulated during childhood.

The information obtained during the intake visit revealed core precipitating and perpetuating causes, as well as minor predisposing causes. Physical stressors — including a 25-pound weight gain, low energy, and a dysregulated appetite — were presented as core symptoms. Psychological stressors included lack of energy, moodiness, irritability, anxiety, feelings of worthlessness, inappropriate guilt, helplessness, and a decline in self-esteem (Dickson et al., 2016). The patient's social stressors centered on worry about his and his partner's financial stability and their ability to maintain a middle-class standard of living. His feelings of guilt arising from relying on his partner's financial support through graduate school and while building his business reflect his empathy and an internalized need to reciprocate — a value likely shaped during childhood.

Principal Symptoms Contributing to the Diagnosis

The principal symptoms leading to the diagnosis of moderate depression were a persistently depressed mood and a loss of pleasure. For a diagnosis of major depressive disorder to be made, these symptoms must be present either behaviorally or as verbal expression. The patient reported moodiness and irritability; additionally, four or more associated symptoms were required to be present and persistent over 12 weeks (Dickson et al., 2016). He acknowledged a lack of positive emotion, persistent moodiness, irritability, and a decline in self-esteem. The depressed mood was expressed both behaviorally and verbally. Loss of pleasure was similarly evident, with the patient reporting decreased interest in activities, a preoccupation with feelings of worthlessness, inappropriate guilt, and helplessness.

The presence of a depressive mood was evidenced by prolonged feelings of worthlessness, inappropriate guilt, helplessness, and diminished self-esteem. Loss of positive emotion was evidenced by persistent anxiety about his and his partner's financial stability and ability to maintain their middle-class standard of living (Clark et al., 2017; Almas et al., 2015). An additional indicator of diminished positive emotion was guilt stemming from his inability to contribute equally at home, which worsened his overall pattern of health deterioration. This guilt was further compounded by his partner's continued financial support and his perceived failure to share equal responsibilities. The patient also expressed fear that his partner must resent him for his absenteeism and failure to take responsibility for the family while continuing to grow his business — though his partner had expressed no such resentment either verbally or behaviorally.

Additional symptoms contributing to the diagnosis included changes in appetite, disrupted sleep, energy loss, anxiety, and weight gain (Almas et al., 2015). The patient reported trouble falling asleep, interrupted sleep patterns, and occasional sleeplessness, all attributable to severe anxiety and worry about financial security. He expressed concern that economic conditions had diminished his ability to save money and caused their savings to shrink, leading to a deterioration of his physical, emotional, professional, and personal well-being.

Irregular sleeping patterns contributed to energy loss, decreased interest in activities such as sex, and a dysregulated diet characterized by periods without appetite followed by episodes of increased eating. Helplessness was evidenced verbally when the patient acknowledged he had lost control of his life and that financial instability was worsening. Anxiety, stemming from uncertainty about future social status and financial security, further disrupted appetite and resulted in irregular eating patterns. Overall, the assessment of the patient's mental, physical, psychological, and social state revealed a depressive mood, dysregulated sleep and appetite, and pervasive themes of pessimism, absence of positive emotions, and diminished self-esteem (Dickson et al., 2016). These challenges permeated his relationship with his partner, as reflected in his decreased interest in sexual activity. The symptoms presented by the patient satisfied the DSM-5 prerequisites for a depressive episode diagnosis and aligned with Beck's Depression Scale classification of moderate severity.