Clinical Case Summary of Woman with Major Depressive Disorder

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1 Summarize the clinical case.
This is a case of a 45-year-old African-American female who presents with anxiety, insomnia, daytime tiredness or exhaustion in general, anorexia, sorrow, inappropriate guilt, and feelings of worthlessness, which started three months prior after her separation from her husband secondary to an extramarital affair. Past medical history revealed a lower extremity neuropathy of unknown origin with no history of personal or familial psychiatric problems. Social history revealed that she is an occasional alcoholic beverage drinker.
The patient’s symptoms are conclusive of a major depressive disorder. According to the Substance Abuse and Mental Health Services Administration (2016), an individual with more than or equal to five of the following symptoms, with one at least a depressed mood or loss of pleasure in previously pleasurable activities, is having an MDD: 1) Depressed mood that is evident with other people’s observation or through the person’s subjective report; 2) The lack of a sense of gratification in previously desirable activities; 3) Unintentional weight loss; 4) Insomnia or hypersomnia; 5) Easy fatigability or lack of energy in continuing daily activities; 6) Inappropriate guilt or a sense of unimportance; 7) Recurrent suicidal ideations; 8) Impaired concentration; 9) Psychomotor changes. In addition, the symptoms must persist for ≥2 months and should not be attributed to any other disease, disorder, or the use of illicit drugs. In this case, the patient had six out of ten symptoms that persisted for more than three months.
2 Create a list of the patient’s problems and prioritize them.
The following problems are listed in descending order:
1 Lack of the ability to fall asleep, poor appetite, decreased energy levels, daytime tiredness
2 Increased levels of anxiety, sadness, and inappropriate guilt
3 Lower extremity neuropathy of unknown origin
Since the patient is a single mother of two 18-year-old fraternal twins, manages the household, and works part-time at a local dry-cleaning shop, the mother cannot afford decreased energy levels during the day. Targum and Fava (2011) explained that reduced energy increases the effort to perform daily tasks and can result in general weakness, daytime sleepiness, and lack of attentiveness. This becomes an issue with the patient since her work requires physical endurance and strength. Insomnia also contributes to daytime fatigue because the body cannot completely rest, and it also increases the risk for continued MDD. Moreover, poor appetite is linked to fatigue secondary to reduced energy production (Sampson, 2018; Li et al., 2018). These are the reasons why these are combined and at the top of the list.
Anxiety, sadness, and inappropriate guilt can all be addressed using non-pharmacologic treatments. Therefore, these fall into the same category. Lastly, lower extremity neuropathy must also be addressed despite not knowing the origin since it may result in a significant disability that may affect everyday functioning. This might also enhance depressive symptoms, such as feelings of worthlessness (Vileikyte et al., 2005).
3 Which pharmacological treatment would you prescribe? Include the rationale for this treatment.
Mirtazapine, a noradrenergic and specific serotonergic antidepressant (NaSSA), shall be prescribed at 15 milligrams (mg), once daily, for 8 to 12 weeks. This is necessary to maintain its concentration in the body for 40 weeks (RxList, 2020; Guzman, n.d.). It also belongs to the group of tetracyclic antidepressants and acts against 5-HTA, 5HT2C, and 5-HT3 recep...