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Case Study: Depression

By Alexis LaChappa

Initial Visit

Psychotherapy

Marital Issues

Carlos initially went to the doctor because he was worried about his heart and the risk of a heart attack, brought on by his cousin recently dying of a heart attack.

Recommendation of a Psychiatrist

Recommendation of a Psychologist

Methods to Remove Cognitive Bias

Cognitive therapy to work on the negative influx of thoughts and emotions to rid Carlos of his depression.

Session 2 Homework

Criteria for Diagnosis

Dr. Willard took into Carlos' symptoms—feelings of despair, poor concentration, difficulty sleeping, loss of interest in activities, and tearfulness—and diagnosed him with depression. He recommended the psychiatrist to advise on the benefits of antidepressants.

Sonia's Concern

The process of psychoeducation, self monitoring, self examination, sustained questioning by therapists, personal research, and retraining in how to think about things. The goal of cognitive therapists is to change the severe negative bias and negative interpretation in order to remove the source of depression.

First Signs

Reasons for No Timetable

Sonia felt as if Carlos was a fifth child, but with less reasoning and less fun, she could at least do those things with her children. The man that she married was no longer the same, as he was scared, sad, and weak. After it seemed like it was getting better and things were looking up, Carlos went into a bout of depression again and Sonia believed she could not put herself or her kids through the same cycle again. She said she had suffered for a year and his improvement was almost too little too late.

Carlos could not get over the possibility of a disaster striking. He had constant thoughts of it, lost interest in all activities, and could not sleep. When describing these thoughts to his physician, he was recomended to see a psychologist.

Carlos was asked to get up and leave for work at 8 a.m. everyday, read a bedtime story to his kids each night and attend the content, and record his unpleasant emotions and the thoughts attached. This was to slowly increase his daily functions and prove to himself that he can function.

Dr. Walton did not want to give a definitive timetable for his recovery because he might not become completely better by that time, and return to his slump of depression.

Initial Medication and Reason for Discontinued Use

Carlos' doctors agreed to the diagnosis of Major Depressive disorder, as Carlos met the DSM-5 criteria. Carlos exhibited a depressed mood,had significantly reduced interest in usual activities, had difficulty sleeping, and had lost his ability to concentrate and his energy.

Evening Routine

Continuing Medication

Medication Additionally with Psychotherapy

Carlos' wife, Sonia, was worried that Carlos would never recover from being a sad, frightened, and weak person. She was worried that she would never get her husband back.

An evening routine for Carlos was helpful in starting to get him to do things with his children and get back into participating in activities. When he learned that he could do it, he knew that he wasn't a basket case that could not function.

Because Carlos was showing improvement, it was necessary that he continue taking his medication, or else he might have fallen into another slump. The risk of relapse is increasingly high when stopping medication immediately after relief. Continuing the drugs for at least five months after relief lessens the risk.

Full Function

Carlos returned to full function within weeks 10-14 of treatment, and was in good spirits during this period as well. Therapy sessions were devoted to avoiding relapse from that point on.

  • Display increase of depressed mood
  • Decrease in enjoyment/interest across most activities
  • Begin suffering from one or more of the following: Considerable weight/appetite change; Daily insomnia/hypersomnia; Daily agitation/decrease in motor activity; Daily fatigue/lethargy; Daily feelings of worthlessness/excessive guilt; Daily reduction in concentration/decisiveness; Repeated focus on death/suicide/plans/attempts

Medication alone was not enough to diminish Carlos' depression to the point where he was functional. Psychotherapy was added to change his mentality, and depression medications were to provide base relief from the de

Initially, Carlos took Prozac, but he could not handle the feeling of the jitters. He described it as feeling as if he were about to jump out of his skin.

Carlos' Homework

Carlos was asked in his therapy session to monitor his emotional reactions throughout the week by recording all thoughts and the activities that triggered them, as well as his activities for the week.

Hospitalization

Dr. Hsu felt as if Carlos was becoming more depressed and thought he himself was headed towards a nervous breakdown due to none of the medications helping his situation due to negative side effects. Hospitalization was due in order to make a more concentrated effort towards finding an effective medication regimen.

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