Major depressive disorder (MDD)

Major depressive disorder (MDD) is currently one of the most common mental health problems in the world. It is one of the most important reasons of mental health problems in the world. (Kupferberg et al., 2016). In the US alone, its 12-month prevalence rate is 10.4% and its total prevalence rate is 20.6%. (Hasin et al., 2019). This paper is a review of a case study that shows how a client who was labeled with major depressive disorder was cared for.

How Present Illness Came to Be

The client, who will be called Jane Doe to protect her privacy and anonymity, is a current LMC Healthcare client. Jane went to the hospital because she had anhedonia, fatigue, “difficulty concentrating, less interest in doing things, and a sad mood.” On her patient health questionnaire-9 (PHQ-9) test, she got a score of 16. The PHQ-9 evaluation test is a tool that can be used to screen for depression, diagnose it, keep track of it, and measure how bad it is. The cut-off points for mild, moderate, moderately severe, and serious depression are 5, 10, 15, and 20, respectively. If Jane Doe gets a score of 16, that means she has depression that is fairly severe. Her anxiety causes her to worry too much and not be able to stop it. She also has trouble resting, gets angry easily, and worries that something bad will happen. Her condition was caused by the death of her husband (which she says she never got over), a bowel blockage after she had a hysterectomy, and, finally, the suicide death of her son.

She said that around the year 1990, she was told that she had both a major mood disorder and a generalized anxiety disorder. At the time, she was sad, tired, had thoughts of death, and wished she were dead. She was also sleeping too much and eating too much when she was upset. She also got an 18 on the Generalized Anxiety Disorder-7 (GAD-7), which is an easy-to-use first screening tool for generalized anxiety disorder. If you get a number of 18, that means you have severe anxiety.

Psychophamarcotherapy

Jane Doe is currently taking 30 mg of Remeron, which is a brand name for the drug mirtazapine, and 25 mg of Zoloft, which is a brand name for the drug sertraline and was added at her last appointment. Mirtazapine is a tetracyclic antidepressant (TCA). TCAs work by stopping the release of serotonin and norepinephrine into the brain, which makes a person feel better. Zoloft (sertraline), on the other hand, is a selective serotonin reuptake inhibitor (SSRI). SSRIs work by preventing serotonin from being taken back up, which makes it work better in the brain. In six to eight weeks, it will be clear how well Zoloft works to treat a big depressive episode. Given how long she’s been taking mirtazapine, it’s likely that she needs a change because the drug is no longer helping her. This is hard, though, because she doesn’t want to take the new medicine because it makes her feel bad. She said that Zoloft made her feel sick, so she quit taking it. After a long talk, she decided to keep taking Zoloft. She was told to take it every other day in hopes that the nausea would go away. She was also told to take the medicine with food to help her body absorb it and lessen stomach problems.

Psychotherapy

One of the main ways to treat major depressive disorder is through psychotherapy. It uses things like cognitive-behavioral therapy and behavioral activation therapy to change the way people act. The best treatment for MDD has been shown to be a mix of pharmacotherapy and counseling. (Otte et al., 2016). Jane Doe would benefit from a couple of sessions of psychotherapy a week, since she has serious depression and has been taking medication for decades without making any big changes. The first few lessons would help her get over the loss of her husband and son the most. She could later go to group sessions where she could talk about her grief with other people who had been through the same thing and get help from them.

Medical Management Needs

Since she takes drugs, it’s important to keep a close eye on how her kidneys and liver work. Liver function tests (LFTs), blood, urea, and nitrogen (BUN), and urea, electrolyte, and creatinine (UECs) are some of the suggested tests for keeping track of how the body works. (Jakovljevic, 2015). She also needs to be told to drink a lot of water so she doesn’t get thirsty. Her primary care provider should give her something to help her eat, like multivitamin tablets, to get her hunger back.

Helpful Tools for the Community

As a nurse, you should care about more than just the patient’s physical needs. You should also think about their mental and emotional needs. The nurse should ask Jane if she has any family members who could take care of her. If there isn’t one, she should be linked to a community center near her home so that workers can take care of her social and economic needs. (Kupferberg et al., 2016). The nurse should also ask about her spiritual beliefs so she can give her the right advice and see if she can be sent to a close church if she is a Christian.

Follow-up

Jane Doe was told that she should have follow-up meetings every two weeks, but she couldn’t do that because she didn’t have a way to get there. So, her follow-up appointments were set up so that she could check in with all of her caretakers once a month.

References

Hasin, D. S., Sarvet, A. L., Meyers, J. L., Saha, T. D., Ruan, W. J., Stohl, M., & Grant, B. F. (2018). Epidemiology of adult DSM-5 major depressive disorder and its specifiers in the United States. JAMA psychiatry, 75(4), 336-346.

Jakovljevic M. (2015). Person-centered psychopharmacotherapy: what is it? Each patient is a unique, responsive and responsible subject. Psychiatria Danubina, 27 Suppl 1, S28–S33.

Kupferberg, A., Bicks, L., & Hasler, G. (2016). Social functioning in major depressive disorder. Neuroscience & Biobehavioral Reviews, 69, 313-332.

Otte, C., Gold, S. M., Penninx, B. W., Pariante, C. M., Etkin, A., Fava, M., Mohr, D. C. & Schatzberg, A. F. (2016). Major depressive disorder. Nature reviews Disease primers, 2(1), 1-20.

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