“Every week a doctor commits suicide in North America, and each one knew that depression is potentially treatable or self-limiting; insight goes faster in depression than in any other illness. Depression is psychological pain, and a severe depressive illness is arguably the most unpleasant disease in the Western world bar rabies. Samuel Johnson once said he’d suffer a limb to be amputated to recover his spirits. An old clergyman who had recovered from a severe depression later badly scalded his genitals, thighs, and abdomen. When asked which type of pain was worse, he said, “I would suffer the scalding a hundred times rather than have a depression again. Every night I pray to God to let me die before the depression returns. When I was scalded I prayed for relief and I was heard, but during the depression I lost my faith. There is no comparison between those two kinds of pain” (Morrant JCA, 1997)
My assignment was to watch and analyze a three-part video series (Southern New Hampshire University, The Case of Barbara and Major Depressive Disorders pt 1, 2 & 3). The series did not give much background on Barbara, but focused on her symptoms and feelings at the time of the interviews. Barbara exhibits many characteristics of a major depressive disorder; she is in an extremely depressed state that has lasted for over two weeks, she exhibits anhedonia (a loss of interest or pleasure in activities), she has impulsive thoughts with suicidal ideations, and her physical level of functioning has been severely affected as a result of a depressive disorder and possibly a medical co-morbidity. We will discuss her symptoms, diagnose her with limited information from the videos, and propose the most effective treatments.
Barbara states to the interviewer that she stays in bed most of the time, not wanting to move. She states that her “arms feel too heavy to lift”. If she can move herself downstairs, she says, it is a big deal, however once there, she is too unmotivated to even change the channel. She does not go anywhere unless she is forced to. She says she still goes to work, but this behavior outside of work has lasted longer than two weeks. We know nothing of “work” behavior from the videos.
Additionally, Barbara expresses to the interviewer that she has thoughts of harming herself. She sometimes feels the impulse to drive off the road but fears that she would not die and become a burden to her family. I would really like to know more about her past. Childhood trauma and physical /sexual abuse can contribute to these types of impulses and “worthless” feelings as “becoming a burden to her family” might suggest. One study published in The American Journal of Psychiatry, concluded that “depressed adults who reported a history of either physical or sexual abuse in childhood were more likely to have made a previous suicide attempt than those who did not report a history of abuse. They also had higher levels of trait impulsivity, higher levels of aggression, and a higher rate of co-morbid borderline personality disorder.
Thus, a childhood abuse history is associated with both suicidal behavior and impulsivity in depressed adults. These findings are comparable to those of other studies that have found associations between childhood abuse history and adult psychopathology in general and between childhood abuse history and self-destructive behavior (such as self-mutilation) and suicidal ideation, gestures, and attempts in particular” (Brodsky,Ph.D, Oquendo,M.D., Ellis, Ph.D, Haas, Ph.D, Malone, M.D. & Mann, M.D., 2001).Additionally, we do not know if she has a history of suicide attempts, but the article mentioned above goes on further to explain “findings suggest that clinicians should be aware of the possibility of a history of childhood abuse in depressed patients with a history of suicide attempts and other impulsive behaviors.” So, clinicians definitely need to be aware of a patient’s history.
Barbara has no interest in anything. Her response to the interviewers questioning in regards to what she enjoys was “nothing”. Anhedonia, the lack of motivation or desire to go anywhere or do anything is certainly indicative of major depression. When someone calls or rings the doorbell, she will not answer it in fear of feeling like she will be obligated to go out in some way. She feels that she cannot say no. This would seem to indicate lack of assertiveness related to self-esteem, or even lack of motivation to even argue a point that might get her out of an invitation. She is completely unmotivated and feels hopeless. This definitely appears to be Major Depressive Disorder, however because of these symptoms; I would first recommend that she have a full medical work-up with her primary care physician to rule out any sort of thyroid function problems, metabolic/endocrine issues, and many other possible causes such as anemia, or vitamin deficiencies.
Barbara is suffering from Major Depressive Disorder. Her current episode has lasted for more than two weeks; she has suicidal ideations though she has not acted on her thoughts. She exhibits feelings of hopelessness, helplessness, and total lack of motivation, preferring to be isolated in her world from family and friends. There may certainly be childhood trauma issues and possibly genetic tendencies, but we do not garner that information from the videos. She may benefit greatly from antidepressants. Per the National Institute of Mental Health : “For severe depression, antidepressant drug therapy is highly effective (for example, in the NIMH study, 76% improved on imipramine and only 18% on the placebo). Antidepressant drug therapy must be given for at least 6-12 months, or even longer (since the NIMH study showed that only 4 months of antidepressant drug therapy for major depression resulted in very high relapse rates)” (Elkin, Shea, Watkins, Imber, Sotsky, Collins, Glass, Pilkonis & Docherty, et al , 1989)
Once she obtains some relief from the medications she should make an effort to attend support group meetings to confront her social issues- her isolation. Additionally, Barbara should set a small goal every day. She might possibly make herself get out of bed when not sleeping at night, get dressed and brush her teeth.
Another coping skill would be to try to replace any negative thought with a positive one. If that seems inconceivable, “fake it” until it feels right. Just thinking positively can have an impact on a person, physically. Finally, Barbara should try to get at least 15 minutes of sunlight every day. Even sunlight through a window can help set off mechanisms to improve mood and enhance vitamin D absorption which does help with depression in many people. If she continues to use avoidance as a means of coping with her illness, her life will not improve and she will move further into depression and despair, making hospitalization necessary as a suicide risk.
Brodsky,Ph.D, B., Oquendo,M.D., M., Ellis, Ph.D, S. P., Haas, Ph.D, G. L., Malone, M.D., K. M., & Mann, M.D., J. J. (2001). The relationship of childhood abuse to impulsivity and suicidal behavior in adults with major depression. (11 ed., Vol. 158, pp. 1871-1877). Retrieved from http://journals.psychiatryonline.org/article.aspx?articleid=175151 Elkin, I., Shea, M., Watkins, J., Imber, S., Sotsky, S., Collins, J., Glass, D., Pilkonis, P., & Docherty, JP et al: (1989). National institute of mental health treatment of depression collaborative research program. general effectiveness of treatments. Arch General Psychiatry, 46(11), 971-982. Morrant, J. (1997). Depression and some newer antidepressants. BC Medical Journal, 39(12), 636-640. Southern New Hampshire University. (Producer). (2013, July 12). The Case of Barbara and Major Depressive Disorders pt 1, 2 & 3 [Web Video].