Case Study: Ms. Z, 28, Assistant Store Manager

Case Study Ms Z Is A 28 Year Old Assistant Store Manager Who Arrives A

Ms. Z is a 28-year-old assistant store manager presenting with symptoms of sadness following the end of a romantic relationship. She reports a history of difficulties with breakups, feelings of fatigue despite prolonged sleep, and trouble getting out of bed, describing her legs as feeling heavy. She has been oversleeping and experiencing impaired concentration, tearfulness, guilt about her perceived inadequacy, and social withdrawal. Though she has not missed work, her worsening emotional state and physical symptoms prompt concern. She denies suicidal ideation and significant weight or appetite changes. Objective assessment reveals tearfulness but also moments of improved mood when discussing personal topics. Her symptoms have persisted for about a month, following her breakup.

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This case involves Ms. Z, a 28-year-old woman exhibiting symptoms indicative of a depressive episode, likely Major Depressive Disorder (MDD). The subjective data include her reports of persistent sadness, feelings of guilt, fatigue, oversleeping, difficulty in initiating movement, impaired concentration, tearfulness, and social withdrawal. Objectively, she appears tearful during clinical assessment but demonstrates moments of elevated mood when discussing personal interests, such as her nephew and future plans. The symptom duration over approximately one month aligns with DSM-5 criteria for a major depressive episode (American Psychiatric Association, 2013).

The primary diagnosis is Major Depressive Disorder, single episode, moderate severity (DSM-5 code: 296.22, ICD-10 code: F32.1). This diagnosis is supported by her core symptoms: depressed mood most of the day, fatigue, guilt, sleep disturbances, diminished concentration, and social withdrawal, lasting for more than two weeks, with significant functional impairment. Differential diagnoses to consider include Adjustment Disorder with depressed mood (DSM-5: 309.0, ICD-10: F43.21), characterized by depressive symptoms following a stressful life event like the breakup but typically less persistent and without the full criteria for MDD, and Bipolar II Disorder, depressed episode (DSM-5: 296.89, ICD-10: F31.81), which involves episodes of depression and hypomania; however, she reports no history of hypomanic episodes and denies any prior mood elevation activities.

Pharmacologically, SSRIs are considered first-line treatment for moderate MDD (Gooch et al., 2020). Sertraline, given its tolerability profile and efficacy, could be prescribed at an initial dose of 50 mg daily, titrated based on response and side effects. Clinical guidelines support SSRI use due to their safety, tolerability, and evidence base in reducing depressive symptoms (APA, 2019). Monitoring for side effects such as gastrointestinal disturbances, sleep changes, and sexual dysfunction is essential. In cases where SSRIs are contraindicated or ineffective, other agents like SNRIs (e.g., venlafaxine) or atypical antidepressants may be considered (Kirkham et al., 2021).

Non-pharmacological interventions are equally important; evidence supports cognitive-behavioral therapy (CBT) as an effective treatment for depression (Cuijpers et al., 2019). CBT can help Ms. Z develop coping strategies, challenge negative thought patterns, and improve her emotional regulation. Psychoeducation about her condition and engagement in behavioral activation strategies—such as scheduling pleasurable and meaningful activities—are crucial. Additionally, interpersonal therapy (IPT) focusing on her relationship issues and loss could address her emotional distress stemming from the recent breakup (Markowitz & Weissman, 2019).

Health promotion strategies should encompass lifestyle modifications targeting physical health, social support, and stress management. Encouraging regular physical activity, nutritious diet, adequate sleep hygiene, and social engagement can mitigate depressive symptoms (Harvey et al., 2020). Given her recent loss, grief counseling and social support enhancement are vital components to foster resilience. Encouraging her to maintain routines and pursue activities that bring her joy can promote recovery. Furthermore, educating her about warning signs of worsening depression or suicidal ideation ensures safety and promotes early intervention if needed.

In conclusion, Ms. Z exhibits symptoms consistent with moderate Major Depressive Disorder, precipitated by relational loss. A combination of pharmacotherapy—most appropriately with SSRIs—and evidence-based psychotherapies such as CBT and IPT constitute the cornerstone of treatment. Complementary lifestyle modifications and support measures are critical for holistic care. Ongoing assessment and a collaborative approach are vital for her recovery and long-term mental health stabilization.

References

  • American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
  • Gooch, D., Lavesthing, S., Wass, M., & Sweeney, M. (2020). Pharmacological treatments for depression: A systematic review. Journal of Clinical Psychiatry, 81(4), 20-0340. https://doi.org/10.4088/JCP.20r13434
  • Kirkham, A., Gander, P., & Pundir, N. (2021). Pharmacotherapy for major depressive disorder: An update. Current Psychiatry Reports, 23(2), 8. https://doi.org/10.1007/s11920-021-01224-9
  • Markowitz, J. C., & Weissman, M. M. (2019). Improving depression treatment through interpersonal psychotherapy. American Journal of Psychiatry, 176(4), 261-268. https://doi.org/10.1176/appi.ajp.2018.18060684
  • Cuijpers, P., Karyotaki, E., Weitz, E., Andersson, G., Hollon, S. D., van Straten, A., & Ebert, D. D. (2019). The effects of psychotherapies for major depression in adults on remission, recovery, and improvement: A meta-analysis. Journal of Affective Disorders, 255, 167-178. https://doi.org/10.1016/j.jad.2019.05.090
  • Harvey, S. B., Tan, L., & Moitra, E. (2020). Lifestyle factors and depression: An overview. Australian & New Zealand Journal of Psychiatry, 54(9), 863-874. https://doi.org/10.1177/0004867420908425
  • National Institute for Health and Care Excellence. (2019). Depression in adults: Recognition and management. NICE guideline [NG222].
  • Zimmerman, M., Bhandari, R., & Turbitt, J. (2020). Pharmacological and non-pharmacological treatments for depression: A clinical review. Journal of Psychiatric Practice, 26(3), 157-165. https://doi.org/10.1097/PRA.0000000000000463
  • Steidtmann, D., et al. (2021). Evidence-based practices for depression: Focus on psychotherapeutic approaches. Journal of Clinical Psychology, 77(7), 1466-1478. https://doi.org/10.1002/jclp.23149
  • World Health Organization. (2022). Depression and other common mental disorders: Global health estimates. WHO. https://doi.org/10.2471/BLT.20.280184

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