Respond to these 3 discussion board posts in 3 different responses, do not combine the three. 1. SM is a 32-year-old female with a history of depression. She presents to the psychiatrist because she has noted signs of depression, including lack of interest in engaging in her hobbies, feeling sad without apparent reasons and crying easily, difficulties in getting up and going, and finding it hard to enjoy playing with her son sometimes. Based on DSM 5, SM has major depressive disorder. SM is in her reproductive age and she plans to conceive in a few months when her husband is done with his studies. Therefore, when managing her, I will consider safe interventions for pregnant and breastfeeding women. From the history presented by the patient, SM’s depressive symptoms can be linked to several stressors such as anticipating becoming pregnant post fertility challenges, financial constraints since she is the only income earner in her family, and the dissatisfying living environment, which she considers as small. Since SM’s depressive symptoms appear to arise from the emotional issues mentioned, the initial intervention in managing her is initiating cognitive-behavioral therapy. This is a time-bound evidence-based psychological approach based on the cognitive model of mental illnesses. It hypothesizes that our emotions and behaviors are influenced by our perception of events rather than the occurrence of such events. That is, it is not the situation that determines how we feel; instead, how we interpret situations affects how we feel (Fenn & Byrne, 2013). Cognitive-behavioral therapy encourages patients to identify and challenge dysfunctional thoughts and replace them with positive thoughts (Gautam et al., 2020). By using CBT, the therapist will help SM to identify thoughts that cause depressive symptoms and replace them with positive thoughts to enhance her mental and physical wellbeing. I would not prescribe an antidepressant (sertraline), which is the first-line medication in managing depression since it is known to cause weight gain and the patient is overweight and has PCOS. References Fenn, K., & Byrne, M. (2013). The key principles of cognitive behavioral therapy. InnovAiT, 6(9), 579-585. https://doi.org/10.1177%2F1755738012471029 Gautam, M., Tripathi, A., Deshmukh, D., & Gaur, M. (2020). Cognitive Behavioral Therapy for Depression. Indian Journal Of Psychiatry, 62(8), 223. https://doi.org/10.4103/psychiatry.indianjpsychiat… 2. From the case analysis, it is evident that the SM is having a depression relapse because she states that she started seeing signs that she used to see in the past. This means that she experienced an episode of depression before. Individuals with depression usually experience sadness, a loss of interest in things they used to like most, social withdrawal, increased irritability, and change in appetite and sleep patterns. These symptoms mostly affect their daily activities because they cannot concentrate and do something. Research shows that depression may occur due to the loss of loved ones, pressure in the workplace, family history, trauma, brain damage, drug abuse, and medical conditions. From this case study, it is clear that the major cause of depression for SM is overwork where she used to work as a nurse for long shift hours, stressful life events, and worries about when and how she will be pregnant since her first pregnancy had problems. Other causes include financial strains and worries about when they will move to a big house. SM’s symptoms of depression can be managed and treated successfully with medication, which will require her to adhere to the treatment to avoid another relapse. Some of the treatments for depression include antidepressants, talking therapies, and exercises (Amick et al., 2015). I will administer depression medications to the client and observe if there are any changes and if there will be a need to provide alternative medications. From the given information, the client states that she was once given medications for such symptoms, but she cannot recall the name of the medications. SSRIs antidepressants like fluoxetine will be of much significance for the client to reduce serotonin reuptake in the brain, thus reducing depression symptoms. Besides, talking therapies like interpersonal therapy can as well help the client to be able to learn skills that will help manage the negative feelings that lead to depression (Amick et al., 2015). Exercise also helps reduce depression symptoms, and since from the case analysis the client does excise, it is good for her to maintain and go on with the activity. Finally, the patient needs to eat healthily, have plenty of sleep, avoid negative things and people, and engage in enjoyable moments. References Amick, H. R., Gartlehner, G., Gaynes, B. N., Forneris, C., Asher, G. N., Morgan, L. C., … & Lohr, K. N. (2015). Comparative benefits and harms of second-generation antidepressants and cognitive-behavioral therapies in the initial treatment of major depressive disorder: systematic review and meta-analysis. BMJ, 351. 3. Based on SM’s case scenario, I will co-manage her PCOS and depression with her OBGYN, antidepressant, and counseling with cognitive therapy. I think the cause of SM’s depression is streaming from her problem with difficulties getting pregnant due to her history of the polycystic ovarian syndrome (PCOS) and overweight, and now her husband is too occupied with work and school that they cannot start working on getting her pregnant. Studies show that PCOS is a heterogeneous chronic disorder of the endocrine system with notable features of depression, menstrual disturbances, and androgens. It is the main cause of infertility and pregnancy complications and causes depression among women (Sadeeqa et al, 2018). The first issue to address to refer SM’s to go see her OBGYN regarding her PCOS so that they can investigate and manage the underline cause. According to studies the etiology of PCOS can be contributed by both environmental and genetic factors (Sadeeqa et al, 2018). Issue number two is managing her depression. Based on SM’s presentation, her depression is getting worse. She is experiencing sadness for no reason, cries easily, having little interest in the things that she used to enjoy doing, finding it difficult with getting up and going, and sometimes does not enjoy playing with her son. She will benefit from SSRI antidepressants like Lexapro 10mg daily to improve her depressive symptoms. Since the leading cause of her depression appears to be streaming from her PCOS, she will also benefit from counseling with cognitive therapy on how to deal with this chronic condition and be persistent with the treatment plan. Reference Sadeeqa, S., Mustafa T., Latif Sumaira (2018). Polycystic Ovarian Syndrome–Related Depression in Adolescent Girls: A Review. J Pharm Bioallied Sci. 10(2): 55 – 59. doi: 10.4103/JPBS.JPBS_1_18 Requirements: see above
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