The physician refers a 32-year-old woman, Alice, a mother of two children (ages 4 and 7), to you to investigate complaints of low mood that began with obvious peripartum depression but failed to resolve even years after her youngest child was born. She reports a positive relationship with her husband of 10 years, and operates a home-based business. She is a social drinker and does not use street drugs. She has a network of supportive friends, good social skills, but has withdrawn from most non-obligatory social contact as a result of her depression. She is of average intelligence and expresses herself well. Caring for her children is her declared first priority, and one of them has not yet started school, so she is occupied during the day while her husband is away at work. She is potentially open to both psychotherapy and/or the use of medication, if so recommended. (That doesn’t mean you have to automatically opt for that!)
The referring physician has conducted a thorough medical evaluation and has ruled out possible contributors to the Alice’s depression such as chronic pain, thyroid abnormalities, etc. There are, however, concerns that she leads a sedentary lifestyle and has been gaining weight. You quickly determine that there are no clinical features of personality disorder, manic episodes, or psychosis. Nevertheless, her score on the Beck Depression Inventory, Second Edition (BDI-II) places Alice in the Severe range of depression. She has not attempted suicide but became tearful when you asked if she currently entertains any thoughts of self-harm.
Alice meets DSM-5-TR criteria for Major Depressive Disorder. Following your initial assessment of her offer treatment. She agrees but has questions about the nature of the services you will provide. Being a responsible psychologist, you opt to review the most treatment guidelines to ensure that you will be provided the best available services. Accordingly, you will proceed through the following steps:
- Open your browser and navigate to https://www.nice.org.uk/
- In the search bar, enter the term “depression”
- The most current update is dated 29 June 2022, and is titled: Depression in adults: treatment and management (NG222). Before clicking that link, scroll down and notice that there are also guidelines for the treatment of depression in children and young people, adults with chronic health problems, and treatment-resistant depression. Also, there are specific reviews of transcranial magnetic stimulation, direct current stimulation, and more. Now click on that first link (NG222).
- Notice that there is broad guidance offered under the heading of “Recommendations”. There are also some visual summaries including decision trees and illustrations that are useful in discussion various options with patients. We’ll return to these, so you might want to bookmark this page for easy access.
Under the heading of “Recommendations“, click “Principles of care.” These are general considerations that contribute to the optimal delivery of treatment services, including the development of a useful therapeutic alliance.
Scroll down to “Initial assessment.”
According to the information in that section, which of the following factors should you enquire about in preparing to offer treatment to Alice?
(Check all that are correct)
a.Any history of depression
b.Co-existing mental health or physical disorders
Scroll down to, and read the section titled, “Risk assessment and management.” What specific advice should the patient and her family be given prior to initiating treatment?
a.Monitor for, and report, any increase in agitation, anxiety suicidal ideation.
b.Participate in moderate exercise at least four times per week.
c.Limit alcohol to no more than two drinks weekly.
d.Commence antidepressant medication under physician’s supervision.
e.Incorporate sources of folic acid and vitamin D into daily diet.