Overview
John presents with diverse mood-related complaints, including sad feelings affecting him since the beginning of freshman year, a decreased willingness to socialize, and perceived worthlessness. Major changes to John’s subjective mental well-being started after graduation from high school. Such changes are multi-dimensional and heavily affect the patient’s mood, social functioning, self-esteem, and sleeping schedules but without disrupting John’s ability to study.
Diagnoses
Based on the case, the main diagnosis for John is major depressive disorder (MDD). The differential diagnoses are bipolar disorder and adjustment disorder with depressive symptoms. Considering the drastic changes between John’s social life and high school and college activity levels, excluding both diagnoses can be essential.
Symptoms
The patient reports multiple general health and psychological symptoms suggestive of MDD. Despite no suicidal ideation, John experiences persistent depressed mood, a markedly diminished interest in previously pleasurable activities, abnormal sleep patterns (difficulty sleeping several times a week), fatigue, subjective worthlessness, and difficulty concentrating. He also looks unkempt, which is among depressive disorders’ common external manifestations. John’s symptoms cause clinically significant impairments in social functioning; they do not seem to be caused by specific substances’ effects or resemble psychotic disorders’ manifestations. However, the history of hypomanic/manic periods still needs to be excluded for a more accurate diagnosis.
Laboratory/Diagnostic Tests
Thyroid function tests and tests to screen for vitamin D deficiency and hypogonadal testosterone values should exclude depressive symptoms’ possible physiological causes. The tests also include screening tools to measure depression’s severity, for instance, the BDI tool, and subsequent questions should be asked to evaluate additional risk factors associated with MDD in college students (Ebert et al., 2019). Such factors include recent partner break-ups, serious interpersonal conflicts, stressful events, and drug/alcohol use (Ebert et al., 2019).
Treatment Plan
Pharmacotherapy, including first-line SSRI drugs, is recommended since it will suppress John’s ongoing low mood while improving his sleep (Dold et al., 2018). CBT treatment is to supplement antidepressant medications’ effects since antidepressant-CBT combination treatments have been shown to produce more pronounced health improvements and functional restoration in mild/moderate MDD than either option alone (Chand et al., 2018). CBT is strongly recommended for MDD patients to correct false and destructive beliefs, so it will be beneficial for reducing John’s perceived worthlessness and the fear of rejection (Chand et al., 2018).
References
Chand, S., Ravi, C., Chakkamparambil, B., Prasad, A., & Vora, A. (2018). CBT for depression: What the evidence says. Current Psychiatry, 17(9), 14-23. Web.
Dold, M., Bartova, L., Mendlewicz, J., Souery, D., Serretti, A., Porcelli, S., Zohar, J., Montgomery, S., & Kasper, S. (2018). Clinical correlates of augmentation/combination treatment strategies in major depressive disorder. Acta Psychiatrica Scandinavica, 137(5), 401-412. Web.
Ebert, D. D., Buntrock, C., Mortier, P., Auerbach, R., Weisel, K. K., Kessler, R. C., Kujipers, P., Green, J. G., Kiekens, G., Nock, M. N., Demyttanaere, K., & Bruffaerts, R. (2019). Prediction of major depressive disorder onset in college students.Depression and Anxiety, 36(4), 294-304. Web.