Psychology Case Study: Diagnosis and Treatment of Depression (Nancy)

This case study presents the case of Nancy, a 27-year-old married woman diagnosed with moderate single-episode major depressive disorder. The study details Nancy's history, including childhood instability, postpartum depression, and current symptoms such as insomnia, withdrawn behavior, suicidal ideation, and loss of interest. It outlines her medical and psychiatric history, including previous treatments with Paxil and Zoloft. The diagnosis is based on her presenting symptoms, ruling out other potential conditions. The treatment plan includes Citalopram, psychotherapy, and lifestyle changes such as dietary adjustments, exercise, and sleep hygiene. The study also highlights the use of cognitive behavioral therapy and the setting of treatment goals. The case underscores the importance of a comprehensive approach to managing depression, combining medication, therapy, and lifestyle modifications.

Running head: DEPRESSION
DEPRESSION
Name of the student:
Name of the university:
Author note:

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History of Presenting Complaint
This is the case study of Nancy, a 27 year married woman living with her husband
and their two sons. Nancy is currently unemployed but her husband does casual work. Nancy
was admitted in mental health acute inpatient ward after her husband noticed deterioration in
her mental state. Her Husband reported that she was suffering from insomnia for about two
weeks and exhibited a withdrawn behaviour along with flattened mood and suicidal ideation.
Her husband felt worried as well as fatigued due to the care that he needed to provide to his
wife. She used to cry and feel sad. She has lost interest in the day-to-day activities. Nothing
seems to excite her, not even the joy of her children. She no more enjoys being a part of any
social gathering that she used to enjoy previously. However she is still putting on weight and
her current weight is 20 kgs more than what she had been recommended. She prefers fast
food and undertakes a fatty diet. She suffers from fatigue and loses her energy after short
errands. She feels nervous, worthless and guilty. She has become indecisive and has been
unable to make sound decisions. On admission, she reported suicidal thoughts.
Patient History /Family and Social History
Neurologically, the patient reported no significant history of problems during her
growth. Nancy was born in a family of 4 which consisted of younger brother, younger sister,
a father aged 57 years and a mother aged 52 years. Her childhood history is characterised by
instability and stressful episodes. Her parents were engaged in domestic violence frequently
due to her mother’s binge drinking habits. The family separated when she was 11 years and
her mother left her and did not return for several years. Nancy’s mother used to communicate
with them over the phone but she did not seek time to visit them. She returned when Nancy
was 18 years old. Being the eldest sibling, she took the responsibility of raising her younger
siblings and conducting other house chores. Nancy reported a period of desperation when her

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mother was away. She started feeling neglected and overworked. Her father took the full
obligation of taking care of the children financially. He used to work for prolonged hours
and seemed frustrated. Nancy always feared to communicate her frustrations and feelings
with her father. This is because she felt that he was not strong enough to take more stress.
When she was of the age of 19, she was sharing a romantic relationship with a boy and then
she got married. She had her first child when she was 22.
Nancy experienced a minor accident in the house that affected her. As a result, she
was not going to work and therefore her employment contract was terminated. She still did
not express her concerns of increased family burdens due to lack of enough finances.
Psychiatric /medical History
Nancy reported beginning treatment of postpartum depression 7 months ago after the
birth of her second son. She realised that she was suffering from depression when she was
pregnant and her suffering continued even after the child was born. Nancy felt like crying all
the time in the first three months of her pregnancy, experienced reduced energy, and always
felt sad and tired. She had lost control of her life. She sought medical help after suffering
from the same feelings post the birth of her son. Her GP prescribed six months dose of Paxil
at 20mgs and Zoloft 50mg daily. Nancy ended up discontinuing the medication upon
realising that her situation was not getting better. According to her, she experienced no
significant differences before and after the medication but she suffered from side effects. She
experienced dry mouth from both medications. However, she admits that she used to sleep
better after the medications were taken. Nancy complained of persistent menstrual flows that
went on for nine days. In addition, Nancy complained to have been on birth control pills
when she conceived her second son. She, therefore, refers to herself as an exceptional person
on which pills do not work.

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The Paxil tablet
People with depression, panic attacks and anxiety disorders tend to have an
unbalanced concentration of serotonin in the brain. The Paxil tablet rectifies this imbalance
and thereby helps to calm the patient. Paxil is therefore meant for treating depression, Post-
traumatic stress disorder (PTSD), anxiety disorders and premenstrual syndrome 9.
Zoloft
Zoloft belongs to the category of drugs called selective serotonin reuptake inhibitors
(SSRIs). It is used to balance the concentration and action of serotonin in the brain. Zoloft
treats depression, anxiety and obsessive-compulsive disorders 9.
Diagnosis
Based on the presented findings, Nancy was diagnosed with a moderate single-
episode major depressive disorder. Nancy was placed on inpatient treatment order level 1
(ITOL1) following medical assessment. She was initially refusing treatment stating that she
wanted to go home. Her conditions were showing features of major depressive disorder.
Major depressive disorder is a mental health condition that is characterised by persistent
depressed mood or loss of interest in activities that affected activities of daily living 13 . She
has reported lack of pleasure and loss of interest in the main events in her life. She also
complained of changed sleeping patterns. She also complained of experiencing guilt and lack
of self-worth. her decision-making process was seen to be impaired and she also could not
concentrate. She had no suicidal attempts but expressed concerns of wanting to escape from
her current situations. Nancy has been experiencing the depressions symptoms for more than
two weeks in a row. It has created a major deficit in her functioning, occupation and social
life 5. She is hopeless and always sad. This positions her to cry often. Therefore, depression

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signs such as phobias, somatic complaints, anxiety and worrying were present. Her
presenting signs and symptoms were found to be similar to those patients suffering from
Major Depressive Disorder. However, she has not reported cases such as hypomanic or
manic. Her prevailing symptoms were not associated with the physiological impact of a
medical condition or substance abuse. Nancy also had not suffered any bereavement and no
death has been reported in her family or friend history. She does not show evidence of
psychomotor retardation or psychotic symptoms.
Basing on the above findings, it can be said that this is not a case of dysthymic
disorder as the depression is not yet over two years 8. It is also wise to rule out the incidence
of Bipolar disorder, as the patients have not shown signs of manic episodes. Medically, no
condition seems present to be contributing to the depression. In addition, she does not abuse
any substance that could lead to a mood disorder.
It is also wise to rule out Adjustment Disorder. Adjustment Disorder is associated
with somatic complaints, substance abuse, and suicide attempts 12 . These conditions are not
present in Nancy’s case. Conclusively, the patient does not suffer from Adjustment Disorder.
Nancy argues that there are some cases of mental illness in the family. Nancy states that her
aunt suffered from depression and believes that her mother could be suffering from
undiagnosed depression/bipolar as well.
Medication/ Therapies
Nancy requires antidepressant medications especially in the group of Selective
Serotonin Reuptake Inhibitors (SSRIs) 4. The medication needs to be taken regularly for about
six months. Serotonin is a chemical that is found in the brain and mainly influences a person
mood 4 .The drug functions by improving sleep and mood. Individuals like Nancy are
exhibiting issues of low amount of serotonin. Therefore, the use of SSRI stimulates the

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production of serotonin in the brain. Citalopram 20mg daily was prescribed. The drug has
little side effect and according to the diagnostic history of Nancy, she is supposed to tolerate
the effects. In case the drugs being not effective after two weeks, Nancy would be
recommended to try Tricyclic antidepressants in the third-week review. Tricyclic
antidepressants are usually considered for those patients whose depression Symptoms are
resistant to other drugs 11. However, the medication comes with side effects that mainly cause
sleeplessness and weight gain. Nancy is not nursing her child as after episodes of depression
she had opted out from the responsibility. Therefore, the medication would be safe for her
consumption.
Oral medication will be preceded by psychotherapy. Psychotherapy refers to talk
therapy with the psychologist 14. It is expected to make the oral medication more effective for
Nancy. The psychotherapies are scheduled after every two weeks but the procedure will
change depending on the recovering process of Nancy. The therapeutic sessions are expected
to help Nancy adjust to the stressful side of her life. It is expected that she would become
more positive about life. The therapies are expected to help Nancy improve her
communication skills and instead of expressing sadness and anger she could channel her
views effectively. It is expected that she would increase self-esteem and regain control and
satisfaction in her life.
Nancy needs to apply lifestyle changes in addition to the psychotherapy and
medications 2. It would be effective in improving the symptoms of MDD. The initial process
that she should be inculcating is the eating foods which contain more of Omega -3 fatty acids
like salmon. In addition, it is expected of her to take many Vitamin B diets including whole
grain and beans that have shown major improvements for patients suffering from the major
depressive disorder. A diet full of magnesium as in yoghurt, seeds and nuts is also
recommended. Nancy would be advised not to consume processed and dried food. It works

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similarly to that of not consuming alcohol. It would be efficient if Nancy engages in routine
exercises in areas that can make her moods better. Sleep is very important and it would be
recommended for her to sleep about 6 to 8 hours on the daily basis. Fish oil 1000 mg daily
and Thiamine 100mg can also be prescribed for Nancy.
Thiamine is essentially vitamin B1. Thiamine can be found in a number of foods such
as cereals, beans, nuts, yeast and meat. Its main role in the body is breaking down
carbohydrates from foods into products that are needed in the body. Thiamine tablets are used
to treat vitamin B deficiency. Thiamine can be taken orally or through injection1.
Fish oil belongs to omega -3 polyunsaturated fatty acids. There are several forms of
omega -3 acids. Fish is one source of omega -3 acids and here they are known as DHA and
EPA. Other sources are vegetable oils and spinach where they are found in the form of ALA9.
Fish oil lowers the level of blood fat called triglycerides which in huge amounts can
lead to coronary artery disease and stroke. Fish oil helps in fighting heart diseases by
preventing inflammation and slowing down plaque build-up in the blood vessels 9.
Most of the therapy sessions concentrated on the cognitive behaviour management as
these interventions were found to be successful in similar patients who presented with the
similar conditions before. Nancy’s treatment goals were splinted down into five sessions.
The first session was the ability to share time with the family and enjoy together. The second
goal was to help her in recovering from the sadness. The third goal would be the development
of her ability to sleep for longer periods and the ability to be firm while providing a negative
response to her friends and families. The goals were very efficient in offsetting therapeutic
sessions. She was explained about the effectiveness of the cognitive behavioural treatment
procedure for depression. It was accompanied by an activity schedule that she completed to
find out whether she achieved the set goals and objectives. The sheet was helpful for her to

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evaluate whether the treatment was effective. She was very excited to tick the goal met but
developed sadness whenever her goals were not met. It was also an important moment for the
nurse to be able to identify her behavioural thoughts and symptoms. The association of her
feelings and thoughts were identified and important issues were discussed with her. The sheet
was very impactful in leading her to a period of self-discovery.
Lorazepam belongs to a class of drugs known as benzodiazepines which act on the
brain and nerves (central nervous system) to create a calming effect that relieve symptoms of
anxiety. The drug works by enhancing the effects of a certain natural chemical in the body
(GABA). This medication may also be used as a treatment for short-term insomnia 7.
Nursing management:
Nursing care management will be very important or Nancy. The nurse shall be
applying both the subjective cues and the objective cues. The subjective cues include
checking of symptoms like lack of appetite, emotional tensions, fatigue, sleep disturbance,
and inability to cope. The objective cues include the inability to resolve the problem,
engaging in destructive behaviour, and inadequacy in solving problems. After the
identification of the problems, the nurse will consider the following management strategies.
She should consider whether Nancy is at risk of self-destruction. It means that whether the
condition can lead to sexual, emotional, and physical harm. It can be prevented by
encouraging Nancy to seek for assistance whenever she feels sad, angry or engage in
substance abuse. In case Nancy is not at risk, then the nurse on duty can make an
arrangement with the family and learn how to control the crisis. In this regard, she will be
required to network as much as possible to keep her away from excessive thinking.
The nurse must ensure the patient has full education regarding issues of personal hygiene and
the self-care 13 . It is advisable to ensure the patient is consuming the right diet. Nancy must

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engage in activities that encourage her energy levels. In addition, she should be encouraged
to communicate by sharing her feelings and the response of the medication. The nurse should
also ensure that Nancy has a full education regarding depression and the importance of
engaging in pleasurable activities and expressing feelings. In addition, she should also
encourage her to seek effective methods of responding to the on setting symptoms.
The nurse should check whether Nancy is responding to the current situations
positively. The patients should have knowledge of understanding the dangers of ineffective
coping behaviours and accordingly respond to them. It is also advisable to create awareness
of the coping feelings and abilities. It is better to be always alert in meeting the physiological
needs such as the use of resources, identification of options and expression of feelings 3.
Discussion/summary:
Nancy complained of insomnia, low mood, feeling of self-condemnation. Nancy
responded well to the cognitive behavioural therapy for the Major Depressive Disorder.
After a few sessions, she showed remarkable improvement and this was shown by the Beck
Depression Inventory scores 10. She reported improved physical signs such as feeling happier,
appropriately making decisions, sleeping better, having more energy, being more active, and
feeling better. She is very optimistic now about the recovering process and it is a positive
sign that she will eventually recover.
Nancy was a bit negative to the antidepressants because of her previous experience. She
reported a mild dry mouth that made her dislike the medication. She is very involved in the
process of identifying and confronting her cognitive distortions that are a positive sign to
manage her depression in a better way. Nancy feels more in control of the situation and she
is recovering successfully discarding the negative thoughts. She has been able to confront the
reality. She also feels that she can effectively handle her life. Nevertheless, she is still having

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episodes of anger that is expected to reduce gradually as she undergoes more therapies and
treatments.
Conclusion
In conclusion, Nancy was suffering from Major Depressive Disorder. She was always
crying and complaining of sadness. She was not capable of controlling her negative feelings
that drove her away from the family and friends. Nancy’s upbringing was unstable and
stressful. Her mother was an alcoholic and engaged in verbal fights with the father. She left
home when she was a teenager that led her to assume household chores. It is a practice that
degraded her position before that of her friends and positioned her to the feeling of socially
deprived and depressed individual. She was diagnosed with depression in the early stages of
pregnancy that prolonged after birth of her child and hence she was termed to be suffering
from postpartum depression. The analysis of her symptoms and the use of the Beck
Depression Inventory showed that her depression rate was very high but decreased
significantly upon the onset of the treatment. She was advised to undergo medical and
psychotherapy treatment. The medical treatment contained the antidepressants and the
psychotherapy treatment contained the sessions that improved the cognitive behaviours.
Finally, it was observed that Nancy was recovering from her depressive symptoms. She
became more positive about life and engaged with friends and family about her condition.
This improvement helped her to overcome all barriers and lead better quality life.
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