Case Study Tina's Story Case Study

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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%)

MDD Diagnosis

"Every time I become depressed, I feel …that the real me is worthless and inadequate. I can't move forward because I become frozen with doubt. But I can't stand still because the misery is unbearable" (Burns, 1999b, p. 29).

The subjective experience of depression has been described as "feeling blue, sad, down in the dumps, or worthless" (Sadock & Sadock, 2003). This is consistent with the depression Tina feels as she also says that she feels her worthless because her husband left her and her friends also do not attend her calls.

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She says that she is not good enough or pretty enough or sexy enough that her husband stay with her.

This inability to take pleasure in experiences or activities that have previously been enjoyable is the definition of anhedonia, one of the requisite symptoms in a major depressive episode (American Psychiatric Association [APA], 2000). In Feeling Good: The New Mood Therapy, Dr. David Burns noted the extensiveness of the effects of anhedonia and depression: "Your mood slumps, your self-image crumbles, your body doesn't function properly, your willpower becomes paralyzed, and your actions defeat you" (Burns, 1999b, p. 28). Clearly, between the experiences of anhedonia and hopelessness, depression profoundly affects one's ability to live life fully engaged, to experience pleasure, to connect with, and to contribute to, the greater world at large. Ultimately, "in its severe forms, depression paralyzes all of the otherwise vital forces that make us human, leaving instead a bleak, despairing, desperate, and deadened state. It is a barren, fatiguing, and agitated condition; one without hope or capacity…" (Jamison, 1999, p. 104).

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.....

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