1. Reply from Daniela Barbeito
Depression Case
Summary of the Clinical Case
Ms. Z is a 28-year-old assistant store manager who appears sad after she had a breakup
one month ago. On the subjective, she complains that she has low mood, oversleeping, fatigue
despite long sleep duration, lack of concentration and that she feels guilty because she is not
good enough to marry. She writes about a past of inability to adapt well to romantic breakups and
her recent social withdrawal, where her friends are worried that she is secluded. Objectively, she
has never missed work but has been late to the office because of oversleeping and has exhibited
emotional instability with customers. In the assessment, she seemed to shed tears though she
showed mood reactivity when talking about positive things, including her nephew and her travel
plans. Significantly, she denies suicidal thoughts and denies any major alterations in her appetite
or weight.
Primary and Differential Diagnoses
The overall diagnosis of Ms. Z is a single episode, moderate, Major Depressive
Disorder (MDD) (DSM-5: 296.22; ICD-10: F32.1). This is justified by her depressed mood,
hypersomnia, fatigue, lack of concentration, excessive guilt and social/occupational impairment
of more than two weeks (McGuinness et al., 2022). The diagnosis is adjustment disorder with
Depressed Mood (DSM-5: 309.0; ICD-10: F43.21), which had the symptoms developed in three
months after the breakup, and the symptoms are associated with a particular stressor. Persistent
Depressive Disorder (Dysthymia) (DSM-5: 300.4; ICD-10: F34.1) is another difference being
viewed as less probable because of the duration of her symptoms (Xiong et al., 2023). The
reactivity in mood that was shown in the interview is indicative of a possible adjustment
disorder, though functional impairment and constellation of symptoms are closer to MDD. Close
follow up is required to ensure that symptoms persist even after the acute stressor has been
eliminated.
Pharmacological Treatment
According to APA and NICE recommendations, the selective serotonin reuptake
inhibitors (SSRIs), which include sertraline or escitalopram, are the first-line pharmacological
therapy of MDD (McGuinness et al., 2022). The SSRIs are chosen because of their desirable side
effect profile, effectiveness and tolerability in young adults. A starting dosage of sertraline of
50mg/day would be suitable and can be increased with tolerance. It is aimed at the elimination of
hypersomnia, fatigue, low mood, and concentration problems. Psychoeducation regarding the
slow-moving effects of antidepressants and compliance must be used alongside pharmacotherapy
in order to avoid premature discontinuation. Follow-up is necessary to control treatment response
and side effects especially due to the occupational commitments and psychosocial stressors of
Ms. Z.
Non-Pharmacological Treatment
Cognitive behavioral therapy (CBT) is the type of non-pharmacological treatment that
has solid evidence on decreasing depressive symptoms and relapse prevention. CBT would assist
Ms. Z to define and reorganize negative automatic thoughts in areas of guilt, self-worth, and
failed relationships. Moreover, behavioral stimulation techniques may encourage her to re-
connect with pleasurable social activities, as they will neutralize her isolation and her lack of
activity. Another possible therapy is the interpersonal therapy (IPT), as her symptoms are related
to relationships, grief, role transitions, and the formation of healthier attachments are put at the
center (Xiong et al., 2023). Psychotherapy is advised as either a standalone treatment in mild
depression or as a combination with medication in severe and moderate depression cases. Ms. Z
is reactive and has strengths including future oriented thinking which can make her respond
positively to therapy.
Health Promotion Intervention
The correct health promotion intervention that would be used in the work with Ms. Z is
lifestyle modification counseling which would include sleep hygiene, physical exercise, and
social connectedness (McGuinness et al., 2022). As is known, regular exercises (e.g. walking or
yoga) may have a positive effect on moods and fatigue. Her hypersomnia would be treated with
sleep hygiene, which would mean that she regularly gets up and not spend too much time in bed.
Changing the order of friends and relatives can help to cure loneliness and to give emotional
support. Resilience can be developed by means of the psychoeducation in relation to the
identification of the initial symptoms of a depression and the ability to coping with stressful
situations in a healthy way (Xiong et al., 2023). These interventions are consistent with the idea
of the holistic approach and provide Ms. Z with an opportunity to be a key participant of her
healing.
2. Reply from Agar D Joseph
Week 4 Discussion
Ms. Z is a 28-year-old assistant store manager experiencing sadness, fatigue, hypersomnia,
difficulty concentrating, excessive guilt, and social withdrawal following a recent breakup. She
reports feeling that she struggles significantly with breakups, spending over 12 hours in bed
daily, and experiencing a sensation of heaviness in her legs that makes it challenging to walk.
She denies any changes in appetite or weight and has no prior psychiatric history. Although she
has not missed work, she has been arriving late due to oversleeping.
During the evaluation, Ms. Z appeared tearful but showed some emotional reactivity when
discussing positive future plans and family relationships, indicating that her mood reactivity is
somewhat preserved. She denied any suicidal ideation but expressed significant psychosocial
distress.
The primary diagnosis is Major Depressive Disorder (MDD), single episode, moderate
severity (DSM-5-TR 296.22; ICD-10 F32.1), as her symptoms of persistent sadness,
hypersomnia, fatigue, impaired concentration, guilt, and functional impairment align with this
diagnosis. A differential diagnosis to consider is Persistent Depressive Disorder (Dysthymia)
(DSM-5-TR 300.4; ICD-10 F34.1), based on her difficulty coping with failed relationships;
however, her symptoms have not been present long enough to meet the two-year criterion.
Another differential diagnosis is adjustment disorder with depressed mood (DSM-5-TR 309.0;
ICD-10 F43.21), since her symptoms are temporally linked to the breakup. Nevertheless, the
severity of her symptoms and functional impairment suggest an episode of MDD rather than a
temporary adjustment response.
For pharmacological treatment, an SSRI, such as sertraline, would be an appropriate first-line
therapy. Clinical guidelines recommend SSRIs as initial treatment for MDD due to their efficacy,
favorable safety profile, and tolerability, especially in young adults without prior psychiatric
treatment (American Psychiatric Association, 2023; Cipriani et al., 2023). Sertraline is FDA-
approved and has a relatively low risk of drug interactions, making it suitable for improving
mood, energy, and concentration.
Non-pharmacological treatments should include Cognitive Behavioral Therapy (CBT), which
is strongly endorsed by guidelines as an evidence-based intervention for MDD. CBT addresses
maladaptive thought patterns, such as guilt and feelings of inadequacy, helping patients develop
coping skills and resilience (Cuijpers et al., 2021). Given that Ms. Z’s symptoms are closely
related to interpersonal stressors and negative self-appraisal, psychotherapy may be especially
beneficial for her.
Additionally, a health promotion intervention would involve encouraging structured physical
activity, such as aerobic exercise three to five times per week, which has been shown to improve
mood, reduce fatigue, and promote better sleep regulation in individuals with depression (Schuch
et al., 2022). Reinforcing good sleep hygiene and encouraging engagement with social support,
such as reconnecting with friends, would also aid in her recovery and help combat feelings of
isolation.
