Reflection Report
The case was about depression. It is basically an episodic mood disorder
characterized by depressed mood and anhedonia lasting for at least 2
weeks. Its more common in females when compared to males, and it
most commonly sets in around 3rd decade of life. Etiology could be from
lack of monoamines ( serotonin, dopamine, noradrenaline), genetic
factors as first degree relative of patients with depression are at
increased risk of developing depression, traumatic and stressful
experiences could cause it. Neurodegenerative disease, and chronic
inflammatory diseases also are etiologic factors. Clinical features
include depressed mood for most of the day, sleep disturbances,
anhedonia, feeling of worthlessness, fatigue, diminished concentration,
weight change, suicidal ideation, at least 5 of these symptoms should
be present for at least 2 weeks. It effects their daily life. The initial
management of adult patients are pharmacotherapy and
psychotherapy, they can be used alone or in combination. For
nonresponders, we can switch to another antidepressant , add an
augmenting agent combining the 2. Therapy should be continued until
the patient is in remission. Most antidepressants require more than 4
weeks to take effect. Initial treatment is for 6-12 weeks. First line is
SSRIs, alternative are SNRIs , Atypical antidepressants. Augmenting
agents are lithium, 2nd gen antipsychotics, thyroid hormones. Lastly, for
severe depression, ECT can be used.
There was a patient named Ms. Corrinne Heathers who came to the GP
with primary complaints of depressed mood, anhedonia, sleep
disorders. Mainly during the day. Also had pain and cramps around the
stomach and legs. She was socially inactive and had no hobbies or
friends. Her mother suffered from a similar condition who is no more.
And she had stopped taking her medication because she thought she
didn’t need it anymore. Lab tests didn’t show any specific changes, she
was suspected of having depression and was referred to a psychiatrist.
She was asked to look for a job, have hobbies, open up to any
relative/friend, and antidepressants were prescribed. She felt better
after 2 months, was asked to continue the medications, the only side
effect was headache but she was also given OTC pain medication for it.
We have to make the patient open up about their problems, because
people who suffer from depression usually don’t talk about their
feelings and thoughts to anyone. We must be their friend rather than a
doctor and understand and listen to them, Things that help with
depression are socializing, controlling stress, healthy diet, regular
exercise, having a hobby and getting enough sleep on a daily basis.
Sigmund Freud believed that a person’s oblivious anger over a loss
weakened the “ego,” which resulted in self hate and self injurious
behavior. Aaron Beck steered in a different way. He believed that
depressives looked at everything in a negative light and blamed
themselves for everything that went wrong. This negative thinking
made situations appear much worse than held true and raised the
chance of depression.
I have never experienced anything like this before as it was my 1st time
in a VPL session, I really liked this session as it shows how a real patient
would present with a problem and we learn what questions to ask and
how to frame them, helps us learn how to deal with patients if we
encounter them in the near future, and interact with other students
and share our knowledge. Depression is not a matter to be taken
lightly, or dismiss it regularly. Hundreds of people commit suicide each
day because of depression. Getting help is the most important part of
dealing with depression.
References :
AMBOSS
Kellymadjad.wordpress.com – 3rd reflection paper.