Running Head: ADOLESCENTMAJOR DEPRESSIVE DISORDER 1

A Case Study of Mary with Major Depressive Disorder

TreSina E. Steger-Smith

Capella University
ADOLESCENT MAJOR DEPRESSIVE DISORDER 2

Introduction

MDD (Major depressive disorder) is a typical, impairing, disabling, and intermittent

condition that predicts future interpersonal issues, misconduct, unemployment, suicide

endeavors, and substance abuse (Kessler and Walters, 1998). Additionally, the condition

represents more than 66% of the 30,000 reported suicides every year (Beautrais et al., 1996).

Given this gigantic result at individual and societal levels, there is a reasonable need to create

and communicate viable medications for this issue. MDD is a disorder that has become a rather

prevalent disorder in United States. This disorder can cause drastic impairments to the patients

diagnosed with it due to the cognitive impairments related with MDD. The cognitive

impairments, particularly cognitive dysfunction, can lead to suicidal thoughts that make MDD a

disorder that needs to be taken seriously (Philip, Gregory, & Ronald, 2003). Many people

experience depressive episodes that differ in severity. Some experience depressive episodes that

cause impairment in their daily functions. These impairments are linked with symptoms of major

depressive disorder (MDD) which will be discussed later. The essay will provide a case report of

the adolescent at various stages of development and include a theoretic analysis of intervention

measures that would be administered to the patient.

A Case Report of Mary with Major Depressive Disorder (MDD)

Mary is a 17 year-old, white American female admitted to doctor's facility as a result of

dynamic suicide endeavors showed by contemplations of hanging herself by wrapping a phone

line around her neck. The issue was accompanied by holding a blade to her arm that afternoon.

Mary has a background marked by suicide ideation and has endeavored to cut herself before, yet

reported that the blade would not puncture her skin. She was concerned that she would not have
ADOLESCENT MAJOR DEPRESSIVE DISORDER 3

the capacity to stop herself once more. She reported depression for as far back as three years and

a passion for death since eighth grade.

Mary is obese and seemed dismal, desolate, looking and exhibiting poor social abilities.

Her affection and love was unconcerned. Mary reported diminished vitality, trouble resting, issue

with her craving, and fractious state of mind. She likewise reported huge sentiments of misery,

uselessness, and weakness. Notwithstanding the above side effects, Mary talked about her

nonexistent companions that she has had since seven years old. The characters are from motion

pictures and TV, and she showcases their voices and contends with them. She distinguishes that

they are not genuine, but rather she will maintain a strategic distance from her companions to

invest energy with her fanciful ones. She reported one sound-related (auditory) fantasy, five days

before her confirmation, as a voice addressing her advising her to get up to rest easy.

These manifestations point to psychological despondency that MDD accompanied by

incongruent or consistent visualizations in the mind. The symptoms are teenage in nature which

is manifested in sound-related hallucinations, delusions, and fantasies. Patients exhibiting

depression more often than not have more extreme depression, a family history of psychotic and

bipolar, sadness more hopelessness, and increased imperviousness to medication treatments.

Ecological variables are likewise connected with to MDD. Mary narrated that her depressive

habit had compounded in the previous 2 weeks since her sister inhabited home once more. Her

sister is harsh towards her (she began gagging Mary for utilizing her computer, television and

other personal property), and Mary trusts her mom does not rebuff her sister legitimately.
ADOLESCENT MAJOR DEPRESSIVE DISORDER 4

Symptoms

Depressed mood

In view of the K-SADS-PL (Kiddie-Sads-Present and Lifetime adaptation) which is a

semi-structured suggestive interview intended to assess significance appraisals of

symptomatology present and past scenes of psychopathology in youths as per the DSM-IV

criteria (Kaufman et al., 1997). One of the principle indications of MDD displayed by Mary is

depression as shown by her moods. This can be portrayed as feeling miserable and tragic. She

complains of irritability in addition to depression. It is critical to assess the impact of the patient,

giving careful consideration to outward appearances, stance, and manner of speaking. This is

especially critical if the individual is trying to claim ignorance about his/her emotions.

Loss of enthusiasm for her exercises/activities

Using the K-SADS-PL Mary was no longer intrigued by things already appreciated.

Mary depicts it as not anticipating anything, or being not able experience happiness.

Weight changes

Using the K-SADS-PL, hunger changes bringing about noteworthy, inadvertent weight

change was seen in MDD manifested as appetite loss.

Sleep changes

Using the K-SADS-PL, Insomnia was evident in MDD. Mary found herself awakening

amidst the night and was not able fall back sleeping. She additionally lay alert, and restless.
ADOLESCENT MAJOR DEPRESSIVE DISORDER 5

Fatigue

Using the K-SADS-PL, excessive fatigue was a noticeable symptom that greatly

impacted Mary. She did not have the vitality to play out the day by daily assignments. Tiredness

is regular.

Feelings of worthlessness

Using the (K-SADS-PL, Mary had serious sentiments of blame as well as worthlessness.

She felt undeserving of the things throughout their life. She is obsessed and experienced

extraordinary blame over present or past occasions. She additionally contrarily confounded

things said or done by others. This propagates the blame and sentiments of unworthiness.

Uncertainty and focus problems

Mary equally experienced trouble focusing on errands. This was a change from ordinary

working.

Intermittent contemplations of death or potential suicide

The fundamental worry with MDD is that of suicide. Mary showed considerations of

death. These contemplations may fluctuate contingent upon the seriousness of the misery. It was

more genuine since she has made an arrangement of how she would submit to suicide.

Intervention Measures

There are various treatments for MDD that have empirical support showing that the

treatment is compelling for the treating the psychological symptoms.

ADOLESCENT MAJOR DEPRESSIVE DISORDER 6

Pharmacological Treatment

A few classes of drugs are utilized to treat depression. Three primary sorts of stimulant

meds incorporate SSRIs and MAOIs. There are some current stimulant medications that do not

fit conveniently into these classes since they have diverse instruments of activity (e.g.,

nefazedone and venlafaxine). The viability rates for these energizer medicines are like the

adequacy rates of SSRIs (Stahl et.al. 2002).

Pharmacological Treatment

IPT (Interpersonal Psychotherapy)

There is adequate confirmation that IPT is a powerful treatment for sorrow. It is normally

suggested as an intense treatment for MDD by various rules and boards (e.g., Depression

Guideline Panel, 1993). IPT has been ended up being similarly powerful as intense stimulant

treatment with amitriptyline for the lessening of misery indications (Weissman 1979).

Marital therapy

Despite the fact that there is adequate proof that marital treatment can be utilized to

viably treat conjugal friction (Beach et al., 2009), there is developing proof that marital treatment

can treat depression successfully. Behavioral therapy is similarly compelling for treating

depression and misery as cognitive treatment (Beach and O'Leary, 1992).

Family-Based-Treatment

This is another sort of intercession that is by all accounts powerful for treating

depression. For instance, extremely discouraged patients that got family treatment will probably

enhance and report less self-destructive ideation than patients that did not have family treatment
ADOLESCENT MAJOR DEPRESSIVE DISORDER 7

(Miller et al., 2005). This treatment adopts a frameworks strategy to comprehension brokenness

inside the family. It expect that: (a) the family is interrelated; (b) one relative can't be totally

comprehended in disconnection from whatever is left of the family; and (c) family association,

structure, and cooperation impact relatives' conduct (Miller et al., 2005).

Behavioral Treatment

Behavioral treatment attributes MDD as a disorder that happens due to learned and

unlearned responses in which treatment is specific to the behavior. The client’s report of MDD

episodes and symptoms are valid and the treatment goal is to change the maladaptive behavior

and replace it with adaptive behavior. Behavioral treatment studies relationship of contingencies

and cues and reinforcement or lack of reinforcement, focused on changing contingencies and to

change behavior. Behavioral therapy has been confirmed to endogenously increase the

production of 5-HT, that is shown through the comparison of behavioral treatment paired with

placebos to pharmacological treatment (David-Ferdon and Kaslow, 2008).

Cognitive-Behavior Therapy is a behavioral treatment that dealing with changing the

feelings and judgments of the person diagnosed with MDD to treat the behavioral symptoms of

MDD. CBT focuses on irrational thoughts of people with MDD in which the individual produces

a negative blame-scheme and identifies events to be extremely negative. The main goal of CBT

is to substitute rational thoughts for irrational thoughts (Beck et.al, 1985). Regarding one of the

main symptoms anhedonia, CBT works to launch a stronger reward system by disrupting the

cognitive irrational thought process that take place with learned helplessness and lack of purpose.

CBT focuses on changing the dysfunctional attitude in individuals diagnosed with MDD and

substituting it with a more functional attitude (Friedman, et.al, 2004).

ADOLESCENT MAJOR DEPRESSIVE DISORDER 8

Psychotherapy is another type of behavior treatment that focuses on the individual

solving problems that were established previous in life. Its main assumption is that the disorder is

caused by unconscious conflicts and childhood problems. The therapist acts abstinent,

anonymous, and ambivalent when engaged with client that is diagnosed with MDD, to enable the

client to resolve the conflict internally on his/ her own (Friedman, et.al, 2004).

Beck’s Depression Cognitive Theory

Aaron T. Beck built up a subjective hypothesis that at first centered on depression and

has been extended to different zones of psychotherapy and psychopathology. He became

dissatisfied with his psychodynamic training since he felt it did not sufficiently account for

clinical and research phenomena he was seeing. Beck’s (1972) theory characterized depression

in psychological terms. He saw the pivotal components of the turmoil as the "psychological

triad": (an) a negative perspective of the world, (b) a negative perspective of the self, and (c) a

negative perspective without bounds. According to Beck (1972), the discouraged individual

perspectives the world through an arrangement of depressive schemata distort understanding

about the world, self, and the future in a negative heading.

As indicated by Dr. Aaron Beck, negative musings, created by broken convictions are

actually the primary driver of depressive indications. An immediate relationship happens

between the sum and seriousness of the individual's negative considerations and the seriousness

of their depressive manifestations (Beck et.al, 1979). Consequently, the more negative musings

the patient encounters, the more discouraged he/she will get to be. The hypothesis can be utilized

to comprehend Mary's issue her behavioral attributes were portrayed by the sentiment being

insufficient or flawed, every last bit of her encounters result in disappointments or annihilations,

and her future is sad. Together, these three subjects are depicted as the Negative Cognitive Triad
ADOLESCENT MAJOR DEPRESSIVE DISORDER 9

for Mary's situation. At the point when these convictions are available Mary's discernment,

despondency is probably going to happen.

The potential impact of Individual differences on development across the lifespan

Lifespan development is described as a shifting allocation of resources in which

individuals encounter losses and gains that require him/her to adapt to these changes. As an

individual passes through the stages of development, adaptation occurs in form of growth,

maintenance and regulation of loss (Broderick & Blewitt, 2010). Childhood is believed to be a

period of growth, adolescence as a time of maintenance and adulthood as a period of regulation

of losses (Broderick & Blewitt, 2010). During childhood, social support occurs on various forms

but the most fundamental relationship is between the individual and their immediate

environment. A sense of social support in childhood will have an effect and/or on all future

development in all spheres of development. The ability of the individual to adapt to the ever

shifting socio-cultural environment can be impacted by the earliest involvement with either a

supportive or a non-supportive environment (Papalia et.al, 2009).

For example, Bronfenbrenner’s Bio-ecological theory demonstrates the impact of the

individual’s microsystem and the bi-directional impact of this environment in which the

environment has an impact on the individual and the individual impacts the environment. The

individual is impacted by the family and any other environmental aspect the individual has direct

contact with (Broderick & Blewitt, 2010). Erikson’s Theory (Papalia, Olds & Feldman, 2009)

hypothesizes that a sense of autonomy, initiative, and trust, are developed in early childhood to

adolescence and are the earliest forms of the quest for identity that lasts throughout an

individual’s life. The path of these stages is impacted by the social support that the individual is

exposed to (Papalia, Olds & Feldman, 2009).

ADOLESCENT MAJOR DEPRESSIVE DISORDER 10

The potential impact of cultural differences on development across the lifespan

Changes in human behavior over the life span comprise biological processes (e.g.,

hormonal production in puberty; biological changes in old age) that are correlated with socio-

cultural factors (Lewkowicz, 2011). Considering culture-specific theory of social development

over the life span, an early noticeable approach is to examine the culture-specific values of

childhood, adolescence, adulthood and old age. For instance, in some cultures, childhood directly

leads to adulthood without transitions such as the developmental stage of adolescence

(Greenfield, 2010). In adolescence, for example, some cultures do not occur because of the

responsibility to take over adult roles immediately after physical maturation (Arnett, 2000).

Possible reasons behind adolescents’ behavior

There are several reasons behind adolescent’s behavior that can lend itself to develop

habits that MDD can present itself. Some of these reasons are rapid brain development, peer

pressure, lack of physical development, and educational environment. Melnyk& Lusk (2013)

state that young people are susceptible to lagging behind in school, lack of energy, and do not

participate in social and school activities. Other symptoms that contribute to the symptoms and

behaviors that exclude in MDD in teenagers could be genetic or situational at home such as

marital. The links that adolescents who have parents or closely related family members who

suffer from other mental illnesses or conditions are more likely to show signs of symptoms.

Adolescents who are in unstable home environments such as such as parents who are going

through turmoil or marital problems (Blodgett, Schaefer, &Haugen, 2014) is a breeding ground

for unhealthy conflict and can contribute to MDD. The strength and bonds of the parent-child

relationship and limit setting can prevent delinquent behavior that occurs from MDD (Lecompte

& Moss, 2014).

ADOLESCENT MAJOR DEPRESSIVE DISORDER 11

There are results that confirm substance abuse and identity exploration in which

commitment to identity was a buffer of identity exploration and substance abuse with similar

groups with similar ages and status. Other groups that have different status, less risky behavior

and low identity-commitment (Dumas, Ellis, & Wolfe, 2012) factor into which each adolescent

tolerates stress and other daily life functions. However, since adolescence is the time for rapid

growth, he or she can lose out on major activities that can prepare him or her for a productive life

and career.

Conclusion

This paper aimed to provide a case report of the adolescent at various stages of

development and include a theoretic analysis of intervention measures that would be

administered to the patient with MDD. It observed that many people experience depressive

episodes that differ in severity. A theory was explored and applied to the case where appropriate

to provide validity to the case and supporting information. The case explored some of the

possible reasons behind the adolescents’ behavior such as home stress, genetics, growth factors

and peer pressure. Some experience depressive episodes that cause impairment in their daily

functions. These impairments are linked with symptoms of major depressive disorder (MDD).
ADOLESCENT MAJOR DEPRESSIVE DISORDER 12

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Appendix

Mary was evaluated on visual and response stimuli and the following were the results:

A. A challenge for the adolescent in terms of identity and self-concept.

In terms of identify and self-concept the challenge for the adolescent is peer-pressure,

habits and overall growth within themselves.

B. Mary’s Strengths and Challenges

Strengths

Mary is 17 with of normal intelligence. She has access to healthcare from her parents.

Challenges

Mary has thoughts of suicide, has been cutting and experience depressed mood. She is an

obese female that appeared sad, lonely, making poor eye contact and demonstrating poor social

skills. Her affection was apathetic. Mary reported decreased energy, difficulty sleeping, trouble

with her appetite, and irritable mood. She also reported significant feelings of hopelessness,
ADOLESCENT MAJOR DEPRESSIVE DISORDER 16

C. Medical, family, and social context.

Medical

Mary is obese but due to the MDD she has experienced appetite changes resulting in

significant, unintentional weight change was seen in MDD. She also lacks energy and

Family

Mary is from a dual parent stable income household. She has one older sister who

exhibits aggressive behavior. Family-based treatment is another type of intervention that seems

Social Context

Mary has lost interest in doing activities that she loves. Mary spoke about her imaginary

friends that she has had since seven years of age and continues to refer to them often. She has

feelings of worthlessness and unable to concentrate in all social environments.

D. Developmental challenges evident in the behavior of the adolescent.

Mary has expressed challenges that are evident in one that has MDD. Her lack of social

skills with her peer group is due to rapid brain development, peer pressure, lack of physical

development and educational environment.

E. Individual and cultural factors that theory and/or research indicate could impact

the child's development.

Research shows that theory-of-mind development has consequences for children’s social

functioning and school success (Astington& Edward, 2010). She still relates to her imaginary

friends and speaks to her peer group about this. By the time a child is 4 to 5 years of age she
ADOLESCENT MAJOR DEPRESSIVE DISORDER 17

should have developed that people talk and act on the basis of the way they think the world is

even though the real world is different.

F. Evidence in the case that the adolescent struggles by not meeting the expected

milestones of Erikson's theory of adolescent development.

Erikson believed if any of the any of the stages were skipped to progress to adulthood at a

healthy pace. He also focused the positive effects of immediate social environments. Mary is not

meeting the milestones by creating close relationships with a close relative, her sister, not

identifying a positive self-esteem within herself and creating a positive immediate social

environment that result in a conducive relationship (school peer groups).

G. Any other factors you deem appropriate based on your understanding of the theory

and related research.

None for this case