M.T. is a 39-year-old female being seen by the PMHNP for a major depressive episode. She is being managed with SNRI therapy in combination with cognitive behavioral therapy.
The PMHNP uses a couple of strategies to help the husband understand the triggers for M.T.’s depression and why treatment is unreasonable if M.T. does not acknowledge her grief. She asks him if he thinks it would be reasonable to expect someone to feel that they have to go on after the death of a spouse or child. He says, ?Of course not.? The PMHNP then shows him a measure on the Patient Health Questionnaire-9 that demonstrates she has given up hope; this measure asks about future goals, and she has circled ?no hope.? The PMHNP explains that this measure informs his assessment that M.T.’s depression is severe, but it is also the case that she has responded positively in the past to treatment when she was convinced she would be able to get better again, so he recommends more cognitive behavioral therapy with her husband present as a support. major depressive episode
Major depressive disorder is a chronic disease that affects at least 14.8 million adults in the United States every year. This illness is characterized by a depressed mood, as well as disturbances in sleep, energy level, appetite, attention, concentration, and motivation. At this point in time, M.T.’s husband understands the disease process of depression. He understands the reasons for effective treatment and the need to be supportive. He understands about relapse prevention and has agreed to read about depression on the Internet or visit with a mental-health professional when needed. major depressive episode
The nature of depression is that one does not recognize the flu-like symptoms as depression. There is significantly increased irritability, problems concentrating and remembering, decreased energy, changes in eating and sleeping habits, feelings of guilt and worthlessness, etc. M.T.’s husband is understandably frustrated because he feels like he really understands how she “feels” (because he can feel it too when she says she feels overwhelmed), and yet he wants to fix her and make her feel better. This is very common in caregivers who witness a person suffering from depression or anxiety – they want to help them “snap out of it immediately.” When M.T. finally is able to verbalize her feelings to her husband (which often takes a downward turn even further), things become more clear to him: now he sees that they are having an effect on M.T., which makes him feel very guilty and sad – but he realizes that this is yet another effect of her illness process, which is often exacerbated by stress and strong emotions in loved ones who see the patient suffer greatly on a daily basis. Once these inter-relational dynamics become clear (and usually after M.T. has been provided psychotherapy for several
For some people, depression is a lifelong disease that can strike at any time. When a patient seems to have no reason to be depressed, the depression may actually be related to an episode of depression in his or her past. The patient may be feeling guilty that they got better while someone they love did not, or they may have had such a difficult time accepting their original diagnosis and treatment that they never tried the treatments needed to get better. In either case, family members are the patients’ best allies when it comes to treatment compliance and maintaining wellness.
Major depressive episodes are recurrent and affect 1 in 5 persons in their lifetime. They have a strong genetic component, and this patient has a first-degree relative who is also affected by depression. The genetic component makes sense because the neurotransmitter system that is targeted by antidepressant medications is known to be directly impacted by genes. This explains why some patients will respond to one medication, while others will do better on another. Each person is different, and treatment must be tailored to each patient’s response.
Diease is a process, not an event. The body, mind and relationships of the patient are involved in their journey to wellness. Once a person becomes ill, multiple biological, psychological, social, spiritual and environmental factors affect the course of the illness and recovery. Each person may experience illness differently as a result of their unique life experiences, disease severity and treatment. Disease progresses at its own pace whether we want it to or not – this is part of the chronic nature of illnesses such as depression. Recovery takes place in steps rather than all at once. A new hope or direction often seems to come from out of nowhere while the person is getting gradually better day by day…
Major depressive disorder develops over time, and it can come back even after treatment with medications and psychotherapy. When it comes back, it is usually worse and more difficult to recover from than the first episode. The disease affects everyone in a family, often making the spouse or other family members angry. When this happens, distancing may develop between spouses or other family members, making recovery even more difficult. major depressive episode
Major Depressive Disorder is a clinical disorder that is caused by several factors, including genetic, biological and psychosocial. The disorder must be present on most days for 2 weeks or more. Patients with the disorder typically have a high level of dysfunction in relationships, work or school activities.
Major depression is a severe and persistent mood disorder that affects approximately 3.5 million American adults. People with depression may also have feelings of hopelessness, helplessness, sadness, guilt, and worthlessness. A depressive episode is considered major when at least five of the following symptoms have been present during a single 2-week period:
Major depression is a recurrent illness, meaning that it can come back. It is much more than just having one bad day or needing to cheer up. When you are depressed, you are having serious thoughts about not wanting to be alive anymore. You have no energy or motivation and you feel negative and sad most of the time.
Major depressive disorder is a severe and chronic mental health condition that causes depression and the inability to function in everyday life. This common mental illness is often thought of as a condition that adults develop, but children and adolescents can also be diagnosed with depression.
Question: major depressive episode
M.T. is a 39-year-old female being seen by the PMHNP for a major depressive episode. She is being managed with SNRI therapy in combination with cognitive behavioral therapy. She is having difficulty achieving remission, and her husband comes with her to this office visit because he is becoming very frustrated. He wants to be supportive, but he is finding it very difficult to understand why she is so depressed. M.T. had an episode of depression approximately 2 years ago, but that was when her sister died in an accident. After 6 months of treatment, she seemed to return to normal. This time, her husband points out that she ?has nothing to be depressed about,? but she has become so depressed that she has essentially withdrawn from the family. In trying to help M.T.’s husband understand the disease process, the PMHNP discusses with him that: