Depressive Disorder
Select an adult or older adult client with a depressive disorder you have seen in your practicum.
The client is a current LMC client with a diagnosis of Major Depressive Disorder and Generalized Anxiety
Disorder. Depression began around 1989. Precipitating factors included her husband's death (killed in a
boating accident and feels she never got over his death); had a hysterectomy and was hospitalized
shortly after for complication (bowel obstruction); and her son completed suicide in 1990. She states, "I
just went to pieces after that". Symptoms at that time included excessive sleep and appetite
disturbances (emotional eating), sadness, fatigue, thoughts of death and wishing she were dead.
Currently, she continues to struggle with depression and anxiety. She's still experiencing anhedonia,
fatigue, trouble concentrating, decreased interest in doing things, and feeling down. PHQ-9 = 16.
Anxiety symptoms endorsed include excessive worry, inability to control worry, trouble relaxing,
irritability, and fear that something bad will happen. GAD-7 = 18. She denies SI, intent, or plan. She
denies panic attacks and anxiety/fear in social settings or performance situations. She denies past or
current a/v hallucinations, paranoia, and no delusions voiced. She denies past or current episodes of
persistent irritability, increased/high energy, increased self-confidence, hypersexuality, spending sprees,
going nights without sleep, talkativeness, and impulsive behavior. She denies history of traumatic
events, nightmares, and flashbacks. She denies recurrent intrusive thoughts, impulses or images and
performing repetitive acts with the inability to resist doing it. Her current medication is Remeron 30 mg
every night and Zoloft 25 mg were added on last visit. Client reports it caused nausea so has stopped
taking. I discussed at length with client that her current symptoms warrant a medication change since
the Remeron is no longer managing her symptoms. She is very reluctant to any changes due to her
reported history of intolerability to most medications’ secondary to gastrointestinal (GI) side effects.
Client is prescribed Zofran and Carafate by her primary medical doctor for GI effects. She agrees to try
Zoloft again so instructed to take it every other day in hopes that nausea will subside. If nausea
subsides, she was instructed to increase to 25 mg daily. Also advise to take Zoloft with meals to help
absorption and decrease GI effects. She voiced understanding. We also discussed adding
psychotherapy and she declines therapy at LMC reporting that she has located several Christian
therapies in the area and plans to contact and initiate therapy with one of them. Recommended f/u in
two weeks but she declines that as well and is requesting an appointment in one month due to
transportation issues.
Recommend psychopharmacologic treatments and describe specific and therapeutic endpoints for
your psychopharmacologic agent. (This should relate to HPI and clinical impression.)
The client is reluctant to take any other medication and advised to resume Zoloft every other day until
GI effects subside. Zoloft is indicated for the treatment of major depressive disorder in adults/elderly
adults. The efficacy of ZOLOFT in the treatment of a major depressive episode is established in six to
eight weeks.
Recommend psychotherapy choices (individual, family, and group) and specific therapeutic endpoints
for your choices. The client would benefit from individual psychotherapy and support groups.
Identify medical management needs, including primary care needs, specific to this client. Labs are
needed to identify any other possible causes related to the ongoing depression symptoms.
Identify community support resources (housing, socioeconomic needs, etc.) and community agencies
that are available to assist the client.
Recommend a plan for follow-up intensity and frequency and collaboration with other providers.
write a treatment plan for your client in which you do the following:
-Describe the HPI and clinical impression for the client.
-Recommend psychopharmacologic treatments and describe specific and therapeutic endpoints for your psychopharmacologic agent. (This should relate to HPI and clinical impression.)
-Recommend psychotherapy choices (individual, family, and group) and specific therapeutic endpoints for your choices.
-Identify medical management needs, including primary care needs, specific to this client.
-Identify community support resources (housing, socioeconomic needs, etc.) and community agencies that are available to assist the client.
-Recommend a plan for follow-up intensity and frequency and collaboration with other providers.
