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Julia is 45 years old and facing the challenge of clinical unipolar depression. Some changes in the brain dynamics can cause clinical depression in individuals after a certain age. Julie might be experiencing the aftereffects of such changes.
Neurotransmitters are the brain chemicals that have been related to several cases of depression (Zuidersma et al. 2013). Change in the functionality of the neurotransmitters may have caused the depressive changes in Julia. The interaction between such transmitters and neurocircuits are supposed to maintain mood stability. In case of Julia, work pressure and mid-life issues may have hampered the interaction and caused the resulting repression.
Julia seems to be in her post or premenopausal period, which indicates, changed in the hormone level. This, in turn, may have caused the depression.
The case study does not provide Julia's family history, but it can be deduced that if Julie's family members had experienced bouts of depression in the past, she might have inherited the same genes that caused depression in her relatives (Aghajani et al. 2014).
Julia is a 45-year-old female recently diagnosed with clinical unipolar depression. Although she was actively involved in an office environment serving as a PA to a government minister, due to the depression she no longer feels that she can cope with the work. The workload seems unbearable; she is no longer enthusiastic about the work. Due to her attitude towards the work she has been signed off from work. The depression has weighed her down and so much so that she no longer considers frequent outings, she has lost her appetite and sleep over the period. She no longer socializes, and Julia has now developed suicidal tendencies. Insomnia and loss of appetite are common symptoms of depression. Suicidal tendencies are caused when the patient loses interest in living or sees no future ahead (Pedersen et al. 2012).
Several treatment approaches can be taken to treat clinical unipolar depression.
Sigmund Freud founded the Psychoanalytic approach (Muñoz et al. 2012). This approach lays a heightened emphasis on the workings of the unconscious and its resultant effect on behavioral aspects. An example of such an aspect is anger turned inward which results in self-harming tendencies. The approach regards the personality as the deciding factor. Ego is burdened with superimposition of guilt and pride on ego. Here we can see the effects on Julia as she has developed suicidal tendencies, which is bordering on self-harm. This therapeutic technique can help Julia identify her own feelings and act with clarity.
Julia’s own traits might have pushed her over the edge and helped in the development of depression. Trait approach involves the working of relatively stable characteristics of an individual (Tournigand et al. 2015). The trait approach considers a group of people instead of considering an individual. There are five personality factors defining the trait approach. There is agreeability, neuroticism, conscientiousness, extraversion and openness. These traits will decide whether Julia’s depression is caused by constant worry, insecurity and self-pity.
The biological approach considers the genetic susceptibility to depression. The approach also considers the serotonin monoamine neurotransmitter theory (Asgari et al.2014). According to this theory, depletion of serotonin from the receptor sites causes depression. This is the kind of depression that can be treated with administration of continued doses of medication over an extended period. Julia has chosen to go back to the doctor because her condition has worsened over time. If the doctor detects depletion of serotonin, then he or she can prescribe medications to supplement the depletion.
While every other theory discusses medications and therapeutic treatment options, this approach actually takes the human nature and conditioning into account (Videbech and Ravnkilde 2015). This approach can be used to change the way Julia views herself as an individual. It can increase self-worth and improve self-concept.
Proper conditioning and observation can achieve changing personal and social behavior (Brown and Harris 2012). The environmental stimulus can strengthen the likelihood of specific response. The way Julia observes the world around her and the way she perceives what is happening around her can decide how she acts. Her depression can be managed by changing the environmental stimulus.
The first line of treatment for clinical unipolar depression is antidepressant, which the doctor can prescribe to Julia if the pattern of depression in her case is periodic (Fava et al. 2014). Psycho and sociotherapeutic approaches can also be used to treat depression in patients like Julia, who has had prior records of medication or therapeutic experience. There are several factors to take into account when treating a patient like Julia with antidepressants. Julia here is returning to her doctor as her condition is worsening. Therefore, it can be deduced that she has had her depression treated earlier. The choice of medication depends upon whether her prior experience with medication and therapy has had positive outcome or not.
If need be, every associated effect of depression has to be treated separately so that Julia can lead a better, healthier life. The treatment plan should take into account the usage of non-psychiatric drugs. If Julia has had a history of using non-psychiatric drugs, then the doctor should consider their effects and side effects before prescribing her some drugs to manage the depression. Patient preference, budget constraints availability of the drugs should also be taken into account (Lin et al. 2013). The unipolar depression in the patient could be easily treated with a single line of drug. The changes in drugs are minimal in cases of unipolar depressive disorders. The cost of drugs is also minimized because the nature of the disorder does not demand to be treated with a variety of medications. Instead, a single prescription of drugs is enough to treat Julia. The success rate of such drugs has been noted to be extremely high. While several side effects have been associated with the drugs, with minimal usage comes the benefits of fewer side effects.
Ethically speaking these drugs are reported to have several side effects. First, they are addictive (Wang et al. 2014). So while administering such a drug careful consideration should be taken into account. The patient history should be considered along with the threshold of the patient. Here Julia's medical history is not mentioned, but the doctor should consider it before prescribing any drug. Not only that, there are several physical side effects of antidepressants and when combined with some other medications the implication of the effect can become huge.
The commonest and the most successful kind of psychological therapy is talk therapy (Sowislo and Orth 2013.). The case study depicts that Julia has currently chosen a life of social isolation. She has stopped going out, going to work or interacting with people. She no longer interacts with family members and has had several episodes of hiked suicidal tendencies. She is on self-harming mode and does not feel the need to connect with people around her anymore. She has chosen to go back to the doctor out of desperation, and talk therapy is the best option for her. Are talk therapies cheap? Not necessarily but if we consider Julia's case, then we should take note of the fact that her condition is worsening. She is getting worse by the second and needs proper assistance, which is unavailable to her. It seems that she is incapable of processing her own feeling for which the resonance approach is the best.
If she talks with a professional, she will better understand herself. Talk therapies have been proven effective in several psychological cases. Moreover, ethically speaking talk therapy is a better tool than addictive antidepressants. It will also help discount Julia’s loneliness.
Aghajani, M., Veer, I.M., van Lang, N.D.J., Meens, P.H.F., Van Den Bulk, B.G., Rombouts, S.A.R.B., Vermeiren, R.R.J.M. and Van Der Wee, N.J., 2014. Altered white-matter architecture in treatment-naive adolescents with clinical depression. Psychological medicine, 44(11), pp.2287-2298.
Asgari, M., Shafran, I. and Sheeber, L.B., 2014, September. Inferring clinical depression from speech and spoken utterances. In Machine Learning for Signal Processing (MLSP), 2014 IEEE International Workshop on (pp. 1-5). IEEE.
Brown, G.W. and Harris, T. eds., 2012. Social origins of depression: A study of psychiatric disorder in women. Routledge.
Fava, G.A., Ruini, C., Rafanelli, C., Finos, L., Conti, S. and Grandi, S., 2014. Six-year outcome of cognitive behavior therapy for prevention of recurrent depression. American Journal of Psychiatry.
Lin, N., Dean, A. and Ensel, W.M. eds., 2013. Social support, life events, and depression. Academic Press.
Muñoz, R.F., Beardslee, W.R. and Leykin, Y., 2012. Major depression can be prevented. American Psychologist, 67(4), p.285.
Pedersen, I., Ihlebæk, C. and Kirkevold, M., 2012. Important elements in farm animal-assisted interventions for persons with clinical depression: a qualitative interview study. Disability and rehabilitation, 34(18), pp.1526-1534.
Sowislo, J.F. and Orth, U., 2013. Does low self-esteem predict depression and anxiety? A meta-analysis of longitudinal studies. Psychological bulletin,139(1), p.213.
Tournigand, C., Canoui-Poitrine, F., Reinald, N., Laurent, M., Guery, E., Caillet, P., David, J.P., Lagrange, J.L., Bastuji-Garin, S., Lemogne, C. and Paillaud, E., 2015, May. Association between geriatric assessment findings and clinical depression in 1092 older patients with cancer: The ELCAPA Cohort study. In ASCO Annual Meeting Proceedings (Vol. 33, No. 15_suppl, p. 1574).
Videbech, P. and Ravnkilde, B., 2015. Hippocampal volume and depression: a meta-analysis of MRI studies. American Journal of Psychiatry.
Wang, P.S., Beck, A.L., Berglund, P., McKenas, D.K., Pronk, N.P., Simon, G.E. and Kessler, R.C., 2014. Effects of major depression on moment-in-time work performance. American Journal of Psychiatry.
Zuidersma, M., Conradi, H.J., van Melle, J.P., Ormel, J. and de Jonge, P., 2013. Self-reported depressive symptoms, diagnosed clinical depression and cardiac morbidity and mortality after myocardial infarction. International journal of cardiology, 167(6), pp.2775-2780.
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