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Eve is a thirty-two-year-old woman who comes to the therapist for treatment of depression. Her current symptoms include the following: depressed mood, apathy, anhedonia, hypersomnia, significant daytime fatigue, suicidal ideations, and low frustration tolerance.

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Make sure to fully respond to each question and to use the rubric
to guide your writing (the rubric is used to determine your grade). Your
assignments should be written in accordance with APA 6th edition
guidelines and contain two professional sources (your text-book may count as
one of your resources). Although there is no minimum page length requirement
for this assignment, you will likely write a minimum of four pages to full
address all of the prompts. Case
Scenario
The
Case of Eve
Eve is a
thirty-two-year-old woman who comes to the therapist for treatment of depression.
Her current symptoms include the following: depressed mood, apathy, anhedonia,
hypersomnia, significant daytime fatigue, suicidal ideations, and low
frustration tolerance. She has experienced five prior episodes of depression.
The symptom picture was much the same during each episode, though in this most
recent episode she reports that her suicidal thoughts have increased. She also
is increasingly pessimistic about psychiatric treatment being helpful for her.
Eve’s first
episode occurred at the age of twenty-one and the second at age twenty-five.
During these first two episodes of depression, each of which lasted
approximately eight to nine months, she was functional but seriously depressed.
She did not seek treatment; apparently in both cases she eventually experienced
spontaneous remissions. In the next episode (her third, at age 27), she did see
a psychotherapist and reports that it was somewhat helpful, but the treatment
(psychotherapy alone) did not resolve her depression. Again she eventually
recovered after twelve months. Again, it was likely a spontaneous remission.
Episode number
four (age 29): Eve was treated by her primary care physician with Zoloft. She
started this medication at a dose of 50 mg qd and she did tolerate it. After
one month on this dose the dose was increased at first to 100 mg and then to
150 mg. After 3 months during which she did not show any improvement she was
switched to Wellbutrin. Again she started with a low dose and was eventually
increased to a dose of 300 mg qd. On both the Zoloft and the Wellbutrin, there
was no significant improvement, but she remembers that she did experience
increased irritability. Since the medication was not effective, she simply
stopped taking it (four months into treatment). Eve continued to be depressed
but somehow tolerated it and never talked to her doctor about it again. By
twelve months her depression lifted.
Episode number
five (age 30): This time Eve saw a psychiatrist and was tried on a number of
different drugs: Effexor (up to 300 mg); Wellbutrin added to Effexor (doses in
the therapeutic range). On Wellbutrin and Effexor she showed a 10% reduction in
symptoms on the Hamilton Depression Rating Scale, but her slight improvement
was accompanied by increased irritability, and that was the reason she stopped
this medication combination after six weeks. The next medication she was
prescribed was Remeron (which she stopped after five days due to excessive
daytime sedation). Next she was tried on Effexor and lithium (she discontinued
the lithium after three weeks due to sedation and nausea). Before stopping she
had attained a blood level of 0.6 and no noticeable improvement. Finally, she
was prescribed Cymbalta; again, not successful. Her psychiatrist diagnosed her
as having treatment-resistant major depression without psychotic symptoms.
She now seeks
treatment for her sixth episode of depression, which began three months ago and
has gotten increasingly more severe.
Eve denies any
history of psychotic symptoms, mania or hypomania, suicide attempts, or
significant abuse of alcohol or other recreational drugs. She does drink four
cups of coffee a day, attempting to stay alert and combat her constant fatigue.
She takes a low dose of Inderal to treat a “mild case of hypertension.” She was
started on this medication about three months prior to her current episode of
depression. She says that she has no other medical problems.
In her first
episode the break-up of a romantic relationship seems to have triggered the
depressive episode. This was the case again in her second episode. However, in
all later episodes there were no noticeable psychosocial stressors occurring
prior to the depression. The depressions seemed to “come out of the blue.” She
is currently married, in a stable and supportive relationship with her husband,
and works as a university librarian.
Family history is
significant. Her maternal grandmother (someone she never met) had had a number
of psychiatric hospitalizations and she killed herself when she was twenty-nine
years old. One cousin has had a “nervous breakdown.” Eve does not know any
details about this. A great aunt was a severe alcoholic, and mother suffers
from moderately severe chronic depression.
Eve says that now
she feels desperate and is plagued by recurring and intense suicidal impulses. Directions: Please
respond to the following questions. All papers should be written in APA format.
Questions
1. Make a diagnosis (and mention possible
diagnoses/diagnoses to rule out), and explain the rationale for the diagnosis. 2. What are the
points in favor of a bipolar II diagnosis?
3.What might
account for the failure to respond to any of the prior treatments?
4. Given the
diagnosis you have made, describe your medication treatment strategies. Discuss
not only initial choices of medications but also your next-step strategy and
why you’ve chosen it. (In doing so, be sure to provide a rationale for your
choices.) What questions should be addressed about the class of medications
that is chosen (e.g., mood stabilizers)?

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