A 42-year-old man visits a doctor with complaints about his disturbed sleeps for last 3-4 months. It happened almost every day in last few weeks .. He had dull headaches in the evening time which was not very painful but upsetting. For last few months he has lost interest on things which used to be his favourite.
Two years back he visited a psychiatrist with similar symptoms. That doctor suggested him to take some anti-depressant medicines. When he started taking, after a month he improved to a great extent. Then when things were alright the doctor helped him to withdraw the medicines by gradually tapering down.
But for last three months his symptoms have re-appeared. He gain feels overly dis-interested with every aspect of his life. His appetite have markedly reduced. He does not feel like working any more.
On further questioning about his family life and past episodes. He said that he is a self employed person for last 10 years. His profession involved transportation. He was initially helped by his uncle to start the business. He was very hard working so gradually he started earning well. later he owned few trucks. Two years back one of his truck met with an accident on the main road and two persons were killed on the spot. His other truck was burnt down by the local public. Then he has to pay huge compensation to the victim's family. That incident affected the financial balance. Which might have been a reason for the episodes of depression he initially want through and treated by the doctor. However it was well managed. But last three months he has similar repeated and continuous experiences of previous episodes of depression again.
He has his own family with a wife and two sons. Both of them are young and still studying in school. His current condition may affect his business and profession. During this time he did not feel like talking to people while in office. He had chronically empty feelings.
Doctor further questioned him about his outlook towards his future life. He did not appear hopeful about his life and lost interest in everything in his day to day life. But he did not show any sign of suicidal ideation. But he feels no energy .. always feel lack of initiative and energy leading to continuous craiving for good sleep .. he continuously feel like resting in bed but his sleep is never a sound sleep and when he wakes up in the morning, he does not feel freshened up.
Analysis
Above case indicates Major Depression.
Following are the presentation of Major Depressive Disorder
- Depressed mood
- Anhedonia (Inability to experience pleasure)
- Significant weight change or change in appetite
- Insomnia or hypersomnia
- Psychomotor agitation or retardation
- Fatigue or loss of energy
- Feelings of worthlessness or excessive guilt
- Decreased ability to concentrate or indecisiveness
- Thoughts of death or suicidal ideation
- Symptoms cause significant distress or impairment in functioning.
- There has never been a manic, hypomanic, or mixed episode.
- Symptoms are not caused by a substance of abuse, medication, or a medical condition.
Possible treatment options
In the above case the suggested treament mode is ...
- Medication with anti-depressants (SSRIs)
- Parallel sittings on Psychotherapy or Cognitive behavioral Therapy
Some general observations about the this disorder.
- It is important to rule out an underlying substance (eg, alcohol and cocaine withdrawal), medication (eg, antihypertensives, steroids), or medical condition causing depression (eg, hypothyroidism, multiple sclerosis), especially if the patient does not have a prior history of depression.
- More than 50% of patients who have had one episode of major depression will have recurrent episodes.
- The risk of further episodes of major depression increases with the number of prior episodes, the occurrence of residual symptoms of depression between episodes, and any comorbid psychiatric or chronic medical illnesses.
- The treatment that was successful for prior episodes of major depression has a higher likelihood of achieving remission in future episodes.
- Selective serotonin reuptake inhibitors, as well as bupropion, venlafaxine, mirtazapine, and duloxetine, are all first-line treatment options for major depressive disorder.
References
APA Guidelines : Treatment of Patients With Major Depressive Disorder, Second Edition
DSM IV Handbook for differential Diagnosis for PDA
Case Files Psychiatry
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