Understanding Depression: A Case Study of Martha

Martha's Story

Martha is a 48-year-old woman who has been living with depression for the greater part of her life, when she was 21 and in college, her brother committed suicide and her mental health declined. A year after that took place Martha was diagnosed with depression. Martha’s grades ended up taking a steep turn for the worse, she never felt like eating much and proceeded to lose weight rapidly. Martha’s family and friends started to take notice and tried to reach out when Martha started to miss work and turned to alcohol to deal with her depression.

She went to see a psychiatrist and was prescribed antidepressants but the medication did not have any success at first and Martha would have to change prescriptions a few times before she noticed any difference, she then started to feel better after a month of use. Martha has since been using Sertraline (known more commonly as Zoloft) and Effexor.

Martha’s mood became much more stable and she was able to find a permanent job at a restaurant, got married, and had two children as well. Martha was doing well academically as she completed one year of a Food Service Management course but she ultimately stopped and regrets not finishing the program. Now Martha feels too old to return to the course after all this time. Apart from that, Martha maintained a B+ when she was still at her local college and took a liking to liberal arts such as (psychology, history, and literature). Recently Martha’s daughter was diagnosed with leukemia,

this set Martha back and pushed her into drinking again. Her psychiatrist changed her medication again but to no avail, and her employment status became unstable again as she went between three jobs in one year. Her family reached out once again and supported her emotionally and financially as best they could but her relationship with her husband has become strained. Due to this Martha has decided to file for a divorce, she says that she will keep on going because of her children but she says it feels so impossible. Nothing seems like it can change or get any better, but she is hopeful for improvements because she has made it through so much already.

Pathophysiology

Depression is a condition where a person’s mood is altered, this can be short term and situationally dependent such as with normal bereavement (grief or sorrow), or chronic and severe (Braun & Anderson, 2017). The exact cause for depression is not known but we do know that biological, psychological, and social factors all contribute to this disability. There is also the heritability of depression which is estimated to be roughly 40% for women and 30% for men for people who have a history of depression within their families.

Pathophysiology of Depression

There are also numerous biological factors that can contribute to the onset of depression such as drug and alcohol abuse (Braun & Anderson, 2017), your brain structure if your frontal lobe is less active (Higuera, 2020), or damage to the cerebellum which can directly cause depression (Braun & Anderson, 2017). People with one or two short alleles of the 5-HTT gene (serotonin transporter gene) are more likely to develop depression given very stressful situations (Braun & Anderson, 2017). The protein carried by 5-HTT or SERT is the main target of many antidepressant medications, especially those of the tricyclic antidepressant class.

Depression is mostly believed to be caused due to a deficiency of neurotransmitters or altercations in the synapses that use neurotransmitters in the brain. A neurotransmitter is a chemical substance that is released at the end of a nerve fiber when it is affected by a nerve impulse, via diffusing across the synapse or junction this causes the transfer of the impulse to another nerve fiber or in this case the brain. Low levels of serotonin would result in low levels of norepinephrine and dopamine and lead to depression (Braun & Anderson, 2017). This theory is supported by the majority of pharmacologic treatments of depression but anti-depressant drugs could take weeks to set in motion their full effects even though serotonin consumption boost levels in just hours of taking them. The reason for this is because people with low serotonin levels are not always depressed and there are also social and psychological influences that we have to take into account too.

Social and psychological influences on depression cannot be ignored. Isolation, social rejection, loss or lack of significant relationships, issues with family functioning, unemployment, poverty, abuse, alcohol/drug abuse, and other severe life stressors are important social influences (Braun & Anderson, 2017).

Treatments

There are quite a few different methods of treatment when it comes to MDD and PDD, things like anti-depressants are quite common for people like us to use in developed countries. As mentioned before there are tricyclic anti-depressants, noradrenaline, which is typically used for people who are unable to take selective serotonin anti-depressants. The few main drugs are SSRI, selective serotonin reuptake inhibitors (Braun & Anderson, 2017) that would generally work for the most part but will not work for people who are not experiencing a problem with 5-HTT.

These are the least dangerous as they have fewer side effects and an overdose would be less serious. Common SSRIs are Prozac (Fluoxetine), Citalopram (Cipramil), and paroxetine (Seroxat).  Apart from medication, there are two more forms of treatments for depression, electroconvulsive therapy (ECT) and psychotherapy/counseling (Braun & Anderson, 2017). In study after study,

Causes of Depression

psychotherapy has been shown to alleviate painful and debilitating mental disorders with thousands of patients throughout the western world (Davidson & Reinecke, 2006). Speaking with a therapist can help you learn skills to cope with negative feelings. You may also benefit from family or group therapy sessions (Higuera, 2020). ECT is typically known as the last line of therapy for MDD, ECT seems to cause changes in brain chemistry that can quickly reverse symptoms of certain mental health conditions (Mayo Clinic, 2018). ECT is a procedure that is typically performed under anesthesia where small electrical currents are passed through the brain and they will purposefully trigger a short seizure.

There is also the importance of providing care to all age groups “Knowledge relevant to the clinical care of elders experiencing depression from a biopsychosocial perspective” (Blazer, 1993). An older person with depression who has nothing left to turn to other than ECT would most likely not be given the permission to undergo such a procedure mainly due to their age and the risks outweighing the rewards. As for some of the alternatives to cope and help with depression, ask your healthcare provider about acupuncture or meditation. Some herbal supplements are also used to treat depression (Higuera, 2020).

I have linked two different sites that are both centered around providing support for anyone dealing with depression of any form. The first link to Coordinated Counselling and Assessment Service is an organization that focuses around Canada to provide outreach and different programs for people who have depression and are trying to improve their situation whether it be with meal plans or behavioral counseling. The second link provided is an organization that is located in Calgary that also provides very similar programs and counseling but they also provide services that branch out to people with bipolar disorder etc. Both of these organizations are dedicated to helping people overcome depression and give them the tools to deal with their inner obstacles while also providing a safe helpline for when you do not know where or who to turn to. They build a community of support and care that is willing to uplift you and listen to your problems.

Link: https://www.ccasweb.com/ | https://mymindmatters.ca/depression/?gclid=CjwKCAjw_sn8BRBrEiwAnUGJDnIuykLQSTVINTDLufCf74HYtwmA0yE4ml2JgwuYCNwdx11-yARwQxoCVN0QAvD_BwE 

1. How would you describe Martha’s condition with respect to etiology and pathophysiological mechanisms? Do you think that the onset and course that Martha’s depression is typical? If so how?

 

2. What are some treatments for depression that you would recommend to Martha? How do they work and what pathophysiological processes are targeted by pharmacological treatment(s)?

 

3. Is there an association between Martha’s symptoms and her use of alcohol? (When she uses it and the frequency that she uses it) Why did Martha have to try several different medications and why didn’t any of the medications resolve her symptoms entirely?

 

4. What are Martha’s friends, family, and co-workers’ opinions about her behaviour and mood? Would their attitudes towards her have any effect in changing her mood and behaviour and why? How does this ‘invisible’ disability affect Martha’s life?