You are a nurse at an outpatient clinic and are presented with a 68-year-old female client. She is experiencing the following symptoms: decreased appetite, disturbed sleep pattern, fatigue, difficulty concentrating, disordered thought process, anhedonia, guilt, and low self-esteem. The doctor diagnoses the client with major depressive disorder. Answer the following questions:
Major depressive disorder (MDD) is a prevalent mental health condition characterized by a persistent feeling of sadness and loss of interest or pleasure in daily activities. It affects an estimated 7% of adults worldwide and is more common in women than in men (Katon & Ciechanowski, 2002). MDD often presents with a variety of symptoms, such as the ones described in the case of the 68-year-old female client. To better understand this client’s condition, it is crucial to explore the various aspects of MDD, including its causes, risk factors, and treatment options.
The precise etiology of MDD remains unknown, but it is believed to result from a complex interplay of genetic, biological, environmental, and psychological factors. Research suggests that genetic predisposition plays a significant role, with a heritability estimation of approximately 40% (Sullivan et al., 2000). Neurobiological factors, such as neurotransmitter imbalances, dysregulation of the hypothalamic-pituitary-adrenal axis, and structural abnormalities in certain brain regions, have also been implicated in the pathogenesis of MDD (Nestler et al., 2002). Moreover, stressful life events, such as loss of a loved one or chronic illness, can trigger or exacerbate depressive symptoms in susceptible individuals (Kendler et al., 2004). Additionally, social and psychosocial factors, including low socioeconomic status and lack of social support, have been associated with an increased risk of developing MDD (Lorant et al., 2003).
The client in question is experiencing several key symptoms of MDD, which are often used to establish a diagnosis according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). These symptoms include decreased appetite, disturbed sleep pattern, fatigue, difficulty concentrating, disordered thought process, anhedonia, guilt, and low self-esteem. However, it is vital to recognize that MDD is a heterogeneous condition, and symptoms can vary greatly among individuals. For a formal diagnosis, these symptoms must be present for at least two weeks and significantly impair the client’s functioning.
The management of MDD typically involves a multimodal approach that combines psychotherapy and pharmacotherapy. Cognitive-behavioral therapy (CBT), for example, is an evidence-based psychotherapy that aims to help the client identify and challenge negative thought patterns and develop healthier coping strategies (Cuijpers et al., 2013). CBT has shown comparable efficacy to medication in the acute treatment of MDD and can be particularly beneficial in preventing relapses (Cuijpers et al., 2008). Another form of psychotherapy called interpersonal therapy (IPT) focuses on improving the client’s interpersonal relationships and addressing any difficulties in social functioning that may contribute to depressive symptoms (Elkin et al., 1989).
Pharmacotherapy is often a vital component in the treatment of MDD, and selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed as first-line medications. SSRIs, such as fluoxetine, citalopram, and sertraline, work by increasing the availability of serotonin in the brain, a neurotransmitter implicated in the regulation of mood (Thase et al., 2001). These medications are generally well-tolerated and have shown efficacy in reducing depressive symptoms. However, it is important to monitor the client for any potential adverse effects, such as gastrointestinal disturbances, sexual dysfunction, and discontinuation symptoms (Cipriani et al., 2018).
In the case of the 68-year-old female client, a comprehensive treatment plan should be tailored to her specific needs by considering various factors, including her medical history, coexisting conditions, and preferences. It is crucial to conduct a thorough assessment to identify any possible contraindications or interactions related to her age and medical comorbidities. Additionally, regular monitoring and follow-up appointments are essential to evaluate the effectiveness of the treatment and adjust it accordingly.
In conclusion, the client’s symptoms align with the diagnosis of major depressive disorder (MDD). MDD is a complex condition influenced by genetic, biological, environmental, and psychological factors. The symptoms of MDD often vary but can include decreased appetite, disturbed sleep pattern, fatigue, difficulty concentrating, disordered thought process, anhedonia, guilt, and low self-esteem. The management of MDD typically involves a multimodal approach that combines psychotherapy, such as CBT or IPT, along with pharmacotherapy, commonly SSRIs. The treatment plan for the 68-year-old female client should be tailored to her specific needs, taking into account her unique characteristics and preferences. Regular monitoring and follow-up appointments are crucial to ensure the effectiveness and safety of the treatment.