Are You Blue? What Do You Do?

A Case Study on Treatment Options for Depression

by
Robert Grossman, Psychology Department, Kalamazoo College
Amy Pettigrew, College of Nursing, University of Cincinnati
Linda Walsh, Psychology Department, University of Northern Iowa
Kathleen Boje, School of Pharmacy, University at Buffalo

"You know Peggy, don't you? She's been so down lately," Brenda said as she, Christy, Bob, Jim,
and Jean dropped into chairs at a table in the Student Union. "She hasn't been at volleyball lately!
We've missed her killer serve! I just saw her. She was mumbling and had tears in her eyes. She
said she had gotten a couple of D's on her mid-terms and was worried about losing her
scholarship. Seems she hasn't been able to concentrate on classes the past two or three weeks.
But what really upset me was she said she doesn't enjoy much of anything any more, not even
volleyball!"
"Did she complain of feeling tired? Listless?" asked Bob.
"Yes, she did," replied Brenda. "She said she's exhausted but can't seem to get a good night's
sleep. Today she woke up at 4:00 AM and couldn't get back to sleep. She told me she felt so
depressed she could hardly get up. I asked her if anything was going on that might be related to
this and she told me her ex-boyfriend is calling almost every night and often threatening
suicide."
"That's real tough," Jean sighed.
"Yeah, I know," continued Brenda. "She's got two years to finish her degree before her money
runs out. I know that she's also worried about her parents' health problems."
"I saw Peggy the other day," Christy interjected. "She was telling me how overwhelmed she feels
trying to take care of herself. She said doesn't have the energy or the appetite to make anything to
eat. She said she thought she may have frightened her roommate the other day. He came in the
other night and found her sitting crying in the dark. That shook her up. She said it reminded her
of when her mother would stay in her room for hours on end."
What is your diagnosis for Peggy? Explain.
Major Depressive disorder - Five (or more) of the following symptoms have been present
during the same 2-week period and represent a change from previous functioning; at least
one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure

Markedly diminished interest or pleasure in all, or almost all, activities most of the day,
nearly every day (as indicated by either subjective account or observation.)

Depressed mood most of the day, nearly every day, as indicated by either subjective report
(e.g., feels sad, empty, hopeless) or observation made by others (e.g., appears tearful).
(Note: In children and adolescents, can be irritable mood.)

Insomnia or hypersomnia nearly every day

Diminished ability to think or concentrate, or indecisiveness, nearly every day

Feelings of worthlessness or excessive or inappropriate guilt

#1 Describe how the following therapists might treat Peggy?

a) a psychoanalyst

Focus on current conflicts, unconscious issues and relationships

b) a humanist (client-centered)

Goal is to help the individual self-actualize

 Unconditional Positive Regard
 Genuineness
 Non-Directive Guidance
 Use mirroring and active listening
 Paraphrase
 You DON’T say “I know how you feel” but you summarize the person’s words
in your own words
 Invite clarification
 What is an example of that?
 Reflect feelings
 ‘It sounds frustrating’ could mirror what you’re sensing from the body
language, tone, etc.

c) a cognitive therapist
Analyze and address a person’s thought processes (negative self-talk)

Attempts to restructure thought processes

 Changing thought patterns will in turn alter problem behaviors and

emotions

#2 Would a behavioural approach or a group therapy approach be useful for Peggy?

Explain your decision for each approach in a way that makes it clear you understand each
approach.

It could be useful but more likely it would be good to use cognitive behavioural techniques.
Group therapy would be good financially but focused therapy is likely to benefit her more as
she has social support available – caring friends – but professional help reframing her
thoughts and behaviours will benefit her.
4 If Peggy goes to a psychiatrist they will likely suggest drug therapy. Briefly describe how
each drug works. Does it have any known side effects?
a) MAO inhibiters

 Inhibit the enzyme monoamine oxidase, which normally breaks down levels of
serotonin, norepinephrine, and dopamine in the brain

 Major drawback is that they can be toxic and interact with foods containing tyramine

b) Tricyclics

 They mainly affect the operation of the neurotransmitters serotonin and

norepinephrine (inhibits reuptake of these neurotransmitters a well as others)– safer
and more effective than MAOIs

c) SSRIs

• an antidepressant drug that specifically inhibits the reuptake of serotonin

without affecting the reuptake of other neurotransmitters

 Usually take 2-4 weeks to show any effect, and may take 6 weeks to be
effective and there can be unpleasant side effects and it can be very difficult to
come off them

d) Which drug would be best for Peggy to take? Why.

SSRIs, fastest acting, most effective, fewest side-effects but should be used in combination
with other therapeutic efforts. Unlikely candidate for lifelong use.