Running head: CASE STUDY ANALYSIS
Case Study Analysis
Author's Name
Institutional Affiliation
CASE STUDY ANALYSIS
Introduction: Case study Presentation
Mary is a 41-year-old woman who presents with a one-month history of poor sleep and irritable
mood, in the setting of a recent divorce and ongoing custody battle with her former husband over
their one teenage daughter. She has also just had a bad performance review at work due to her
inability to meet deadlines and is fearful of losing her job. She explains that her work problems
have arisen because she has been unable to keep her concentration focused on work. She
expresses feelings of worthlessness and wonders sometimes what the point of living is? She has
to force herself to stay engaged in her children's activities and other interests that she used to
enjoy; she feels she is "just going through the motions." She had a similar episode after the birth
of her daughter but pulled out of it after several months. There is a family history of suicide; her
father killed himself when the patient was 18 years old. Her exam is notable for poor eye contact
and frequent tears. Her test results, including the thyroid-stimulating hormone, are normal.
Part A: Clinical Assessment
After several tests and an examination of her patient history, Mary was diagnosed with Major
Depressive Disorder (MDD). Essentially, this is a disorder caused by a combination of various
biological, psychological, and social sources of distress. According to Mayo Clinic (2019), some
of the major symptoms of MDD include: feelings of sadness, emptiness, and hopelessness,
irritability, loss of interests, in normal activities, tiredness, loss of appetite, anxiety, agitation,
slowed thinking, trouble concentrating, and recurrent suicidal thoughts. These are some of the
key symptoms exhibited by Mary.
As mentioned earlier, MDD is caused by a combination of various factors, including biological,
psychological, and social factors. One of the major risk factors of MDD is genetics-i.e. it is more
CASE STUDY ANALYSIS
in individuals whose blood relatives also have the condition. Mary's medical and psychiatric
history reveals that some of her close blood relatives, such as his father has committed suicide
due to MDD (Kupfer et al. 2016). The other possible factors contributing to Mary's MDD
condition are biological differences and brain chemistry. Physical changes in the brain, coupled
with changes in function and effect of neurotransmitters, play a significant role in MDD as well
as its treatment. However, researches have not been able to correctly determine exactly how
these risk factors contribute to the condition.
Part B: Therapy Session
Doctor: Nice to see you, Mary, how are you today?
Mary: Oough! Mmh,..I'm ok.
Doctor: I understand you have been referred here by our GP because you have been having
sleeping difficulties and mood problems r recently…could you please briefly explain when the
problem began and how it has been for you?
Mary: Mmmh….well, over the last few months ago, I have been through a lot…I have been
feeling quite bad for a while, so I thought it is good I com for some help.
Doctor: Ok….so, from the records, I see you came to see the GP two months ago…
Mary: Yeah…
Doctor: So how long have you been feeling like this?
Mary: Quite a few months before that but it is getting worse the last few weeks….that's why I
came to see if you guys could help me because I don't wanna feel like this anymore.
CASE STUDY ANALYSIS
Doctor: Its ok, I here for us to work together and come up with a solution….so tell me,
Mary, ..How are the things at the moment?
Mary: ..Mmmmh…like honestly, I am feeling down, I am losing interest in pretty everything I
used to love, my moods are bad most of the time……and at night I can't find any sleep. I really
don't know what is happening to me..
Doctor: ooh, sorry to……
Mary: ..and I am trying to get motivated to do things and work like everyone, but I honestly
can't…Its kinda reaching the end, and I desperately wanna do something about it…
Doctor: Ok…I understand. So feeling really sad down yourself and your mood….like you have
got no motivation… Um-um, and it sounds as if you have been under a lot of pressure to make
yourself feel better?
Mary: Yeah…its sometimes very difficult because.. Um-um., when you have no one to talk to
feels very hopeless. This makes me feel very worthless and not valued by anyone.
Doctor: So, you say you have been kind of isolated and lonely? …there is no many people
around that you can talk to?
Mary: Absolutely…I have no one to share with...I don't think anyone would understand it..
Doctor: I am just trying to better understand this…..I understand that you are in the process of
finalizing a divorce and child custody issue. Can you please tell me more about that, if you don't
mind?
Mary: Well, the bottom line is that I have had problems in my relationship with my husband,
and the father of my daughter. It has become increasingly difficult to live and reason with him…
CASE STUDY ANALYSIS
and that's why we are working on the divorce issue. ..Sounds weird to discuss these intimate
issues with a stranger but….
Doctor: I understand that it feels a bit uncomfortable discussing such an intimate issue with an
outsider. However, it is always advisable to gain a different perspective whenever things become
difficult…I am here to work with you towards the betterment of your health.
Mary: Thank you, Doctor…
Doctor: You said you are currently working on as direct and child custody issue, and it appears
this is taking a toll on your health…so how long have you been married, please?
Mary: Fourteen and half years…but lately, the marriage has been chaotic; that's basically why
we are getting divorced….
Doctor: Ooh, ok. And you said you a daughter? Do you have any other child?
Mary: Nope, we only have one daughter….and she is turning 15 years next month
Doctor: And what do you think or feel about the divorce?
Mary: Personally, I do not want to get divorced….i really love my husband and my daughter,
and it is very traumatizing for me to separate them….Just thinking about it is giving me sleepless
nights and I would I could overcome the awful feeling and hopelessness……..Its awful Doctor!
Doctor: I am sorry to hear that Mary, I absolutely understand the feeling. Anyone would feel the
same in similar circumstances…..however, the important insight here is that your husband
wanting to leave you and your daughter makes you feel awful, stops you from getting things
done. Basically, psychologically it is not essentially the bad events themselves that make us feel
mentally disturbed or stressed but rather our thoughts in our heads about the situations…thoughts
CASE STUDY ANALYSIS
like "I must not lose my husband or I need her love and approval, or I must be a better wife" .. it
is natural to feel like you have lost or responsible for bad occurrences
Mary: Ok, ok…
Doctor: And have you talked with your husband about it?
Mary: Yes! Numerous times….but every time we talk about it, the worse it becomes for me
because he is always blaming me. This makes me feel awful…like a loser.
Doctor: Alright…and what abou…..
Mary: My disturbed and awful feelings are making it difficult to even concentrate at work. Last
week I had a bad performance review due to my inability to meet deadlines basically because I
am preoccupied with my divorce problem.
Doctor: It is understandable and occurs often…please tell me about your job and how your
disturbed psychology is affecting your performance.
Mary: I am on the brink of losing my job doctor because I can't concentrate on anything….the
other months it has been batter but lately, I am finding it extremely difficult to complete any
task. I have lost all my motivation to wake up and go to work…Its peak season for our company
and everyone is already working hard to meet the new deadlines and output. I am the only person
in the company who seems not to put in any effort.
Doctor: So you have lost your motivation to work hard and the company has already given you a
negative performance review?
Mary: Yes, Doctor. My supervisor thinks I am rude and "always moody." And I am losing
interest the job its only that I have a daughter to feed and aging parents to take care of…
CASE STUDY ANALYSIS
Doctor: It sounds like you are undergoing a bad experience at work. ..with all these happenings,
how has your sleep been, Mary?
Mary: It takes me ages to go sleep, and sometimes stay wake the whole night. I used to read a
book or watch some movie and I drop off…but lately, I just spend the time watching the clock
go round and round.
Doctor: So going to bed and getting sleep….how long is that taking?
Mary: A couple of hours
Doctor: Ok..and when you wake up during the night…do you get back to sleep or how has it
been like?
Mary: No, its difficult.
Doctor: And when you are waking up in the morning, do you still tired or something?
Mary: I feel exhausted, and my brain still feels switched off
Doctor: Ok, and how has your eating habits or appetite been like?
Mary: I used to have weight problems but lately, all my clothes are loose as you can see. I cook
for my daughter, but I rarely bother to eat…
Doctor: So, your appetite has gone down. What about your memory or concentration both at
home and at work? Like when you are watching TV or doing your things?
Mary: It's been terrible…the other day I forgot to lock our main door only to realize it in the
morning…Last weekend I forgot swimming money for my daughter….also while coming here I
CASE STUDY ANALYSIS
almost left home without doing my hair, it's been awful. Like I have lost concertation and its
really been bad for me.
Doctor: Um-um…
Mary: I used to love and watch EastEnders, but not anymore. I begin watching the soap but
after 10 minutes I am thinking about something else...
Doctor: ok, ok …and, how is your daughter? How has it been taking care of her with the
ongoing difficulties in your life?
Mary: At least, she is self-sufficient…she comes from school makes her own tea...yeah, but
should be doing more for her.
Doctor: Ok, and what about taking care of yourself?
Mary: As you can see I am just in a bad mess….Bill used to say, that is my husband, that I am
beautiful because I am always doing my hair and stuff. But not anymore, I have lost all the
interest in on taking care of myself as a woman…I can't be bothered with any anymore…there's
no point, really.
Doctor: Ok, so can I just get a recap of how you have been feeling the last few weeks to check if
I got this right. So for the last three to four weeks you have been feeling down, you have lost
interest in things you used to love doing, problems with your sleep and eating, problems in
concentrating especially at work, feelings of worthlessness, perhaps you have been struggling
with the kid, and your relationship with your husband has not been a difficult one. Have I got
that, right?
Mary: Hmmmmm...Correct.
CASE STUDY ANALYSIS
Doctor: Alright…so, can I ask Mary, in the past, have you felt this before, or have you ever been
treated for the same problem before?
Mary: When I gave birth to Charity, my daughter, that is fourteen years ago…I experienced a
similar problem, but it never got this worse.
Doctor: Mmmh…please go on and explain the problem back then. My daughter was born at a
time when my father had committed suicide for stress-related problems. It was one of the most
difficult moments of my life. However, my husband took me to a physical, and I was diagnosed
with post-traumatic stress disorder (PTSD).
Doctor: Ooh, I am sorry to learn you have been through such torrid times….I will be coming
back to that later, but for now, we can continue with your PTSD problem back then. How did
you feel then?
Mary: ok …well, I having flashbacks and haunting nightmares, and it was really scared of
anything, or anyone is talking about death…also my husband always I was being hypervigilant.
But after being treated for about six months, everything became normal, and since then I have
never felt the same again.
Doctor: ok, its good you are letting me know about these experiences. They are important in
your treatment Mary.
Mary: I appreciate it a lot, Doctor. Its long since I shared anything like this with anyone.
Doctor: Its ok…now, Mary you talked about your father. Can you please let me know what
happened to him?
CASE STUDY ANALYSIS
Mary: Well, while I was about to give birth to my daughter, my father committed suicide. He
was working with a rail company in Minnesota. It was absolutely traumatic because he never
explained the reasons behind his decision. I don't think I have been able to get over it even now.
Doctor. Sorry to hear that.
Mary: However, we later learned that our dad had been undergoing depression treatment for
about three years before he committed suicide. None in our family knew anything about it.
Doctor: ok, and is there anyone else in your family who has suffered from the problem? I mean
close relatives dead or alive.
Mary: No, although my grandfather is being treated for anxiety disorder, but his is not a serious
problem.
Doctor: Ok, and I know it might difficult question to ask you, but its important given your
situation….have you ever thought or pondered about harming yourself or suicide, maybe?
Mary: Well, I have been a victim of suicide, and I know how it feels for those left behind…buy
you now know things get so thick sometimes that you find yourself contemplating ending your
life. I have sometimes thought of giving up and killing myself, but it's my lovely daughter who
gives me the desire to push on.
Doctor: I know Mary, but.
Mary: Personally, I have planned anything about it, but its something that crosses my mind,
especially when I feel down and totally hopeless.
Doctor: And have you thought about harming daughter as a result of such experiences? Or
anyone else for that matter?
CASE STUDY ANALYSIS
Mary: No, not at all…. I'd never do anything like that to my daughter. She is every reason why I
am pushing on. You know Doctor, children do some things that make you smile and cherish life
despite all the bad things.
Doctor: Absolutely true. And what about the other side, positive things you can live
for….things that make you feel good?
Mary: Its only my daughter, mom, siblings, and my grandfather. I would really be in good
health and a position to help them…make them smile and good things in life.
Doctor: And you feel able to keep yourself safe at the moment from hurting yourself or another
person?
Mary: I am stable, but I need someone I would share my struggles with.
Doctor: Alight…so Mary, what do you think we should be done to improve your condition?
What do you expect the treatment should achieve for you?
Mary: I just want anything that will help me feel better and return me back to my original
self….I want to be a better mom to my child. I want to work hard like anyone at work. .And I
want to be happy in life.
Doctor: Alright Mary…I will be doing my best to help you achieve your dreams. Thank you
Part C: Therapeutic Intervention
There are several therapeutic interventions that could be employed to help treat Mary's condition.
Noteworthy, a combination of psychopharmacological and nonpharmacological interventions is
more preferable for better outcomes.
Psychopharmacological Interventions
CASE STUDY ANALYSIS
To help alleviate Mary's MDD symptoms, citalopram (Celexa) should be prescribed for her.
Essentially, citalopram is a drug belonging to a class of medications known as selective serotonin
reuptake inhibitors (SSRIs). SSRIs usually work by increasing the serotine in the brain and
blocking inhibiting reuptake. For this reason, there is more serotonin to pass messages between
nerve cells. However, citalopram may have some side effects such as dry mouth, nausea, fast
heartbeat, and headache.
Psychotherapy
To improve the patient's treatment options, citalopram should be coupled with
psychotherapeutic interventions. Cognitive-behavioral therapy (CBT) is effective psychotherapy
that employs behavioral strategies and cognitive restructuring to change the patent's negative
automatic thoughts while also addressing maladaptive schemas. According to Medscape (2019),
CBT is founded on the premise that patients who suffer depression exhibit a "cognitive triad" of
depression. These include a negative view of themselves, the world or environment, and the
future. CBT is very important for this patient because it will help to replace negative beliefs and
behaviors with more positive and healthy ones. It will also be used to help the patient regain a
sense of satisfaction and control of her life, which will help her return to her normal life. Given
her loss of motivation and loss of interest in activities she used to love, CBT will help increase
her self-esteem, improve her communication skills, and, more importantly, adjust to the crises
affecting her life. The other types of therapy that the Doctor may consider include:
Electroconvulsive therapy (ECT), Transcranial magnetic stimulation (TMS), among others
(Kennedy, et al. 2016).
Other than the above-mentioned interventions, there are several other nonpharmacological
services that can be employed to improve the patient's condition. For intake, the patient should
CASE STUDY ANALYSIS
consider lifestyle changes that will help her overcome her depressive thoughts and state. For
instance, the patient should be getting plenty of physical exercises. According to Jackson (2013),
physical activity, particularly outdoors and in moderate sunlight, helps to boost the patient and
makes them feel better. Exercise is an effective component of a stress management program, and
various types of exercise have different benefits or stress management. For this reason, the
physician should develop an effective stress management program that includes physical
exercise in order to help this particular patient overcome her depressive thoughts. Moreover, it is
important for the patient to seek psychological support from people around her who she can trust.
Talking out her problems will go a long way in preventing her MDD from worsening.
CASE STUDY ANALYSIS
References
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Medicine, 358(1), 55-68.
Campillo, I. S. L., Meaney, S., McNamara, K., & O'Donoghue, K. (2017). Psychological and
support interventions to reduce levels of stress, anxiety or depression on women's
subsequent pregnancy with a history of miscarriage: an empty systematic review. BMJ
open, 7(9).
Kennedy, S. H., Lam, R. W., McIntyre, R. S., Tourjman, S. V., Bhat, V., Blier, P., ... &
McInerney, S. J. (2016). Canadian Network for Mood and Anxiety Treatments
(CANMAT) 2016 clinical guidelines for the management of adults with major depressive
disorder: section 3. Pharmacological treatments. The Canadian Journal of Psychiatry,
61(9), 540-560.
Kupfer, D. J., Frank, E., & Phillips, M. L. (2016). Major depressive disorder: new clinical,
neurobiological, and treatment perspectives. Focus, 14(2), 266-276.
Mayo Clinic (2019). Depression (major depressive disorder). Retrieved from
https://www.mayoclinic.org/diseases-conditions/depression/diagnosis-treatment/drc-
20356013
Medscape (2019). What is cognitive-behavioral therapy (CBT) for the treatment of major
depressive disorder (clinical depression)?. Retrieved from
https://www.medscape.com/answers/286759-14774/what-is-cognitive-behavioral-
therapy-cbt-for-the-treatment-of-major-depressive-disorder-clinical-depression
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Parikh, S. V., Quilty, L. C., Ravitz, P., Rosenbluth, M., Pavlova, B., Grigoriadis, S., ... & Milev,
R. V. (2016). Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016
clinical guidelines for the management of adults with major depressive disorder: section
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