Case Summary
A 32-year-old male patient presents with a history of persistent depressive episodes since adolescence. He has experienced several depressive episodes, each lasting several months, characterized by low mood, anhedonia, fatigue, difficulty concentrating, and social withdrawal. He has also experienced several mixed episodes, characterized by the simultaneous presence of depressive and manic symptoms.
The patient has a history of significant substance use, including alcohol, cannabis, and cocaine. He has also made multiple suicide attempts. His past medical history is otherwise unremarkable.
DSM-5-TR Diagnosis
Based on the information provided, the most likely DSM-5-TR diagnosis is:
Recurrent Major Depressive Disorder (296.32) with Mixed Features
This diagnosis is based on the following criteria:
- The patient has experienced at least two depressive episodes, each lasting at least two weeks.
- The patient’s depressive episodes are characterized by at least five of the following symptoms:
- Depressed mood
- Anhedonia (loss of interest or pleasure in activities once enjoyed)
- Significant fatigue or loss of energy
- Difficulty concentrating or making decisions
- Restlessness or psychomotor agitation or retardation
- Feelings of worthlessness or guilt
- Recurrent thoughts of death or suicide
- Psychomotor agitation or retardation
- Sleep disturbances (insomnia or hypersomnia)
- Changes in appetite
- The patient’s depressive episodes are not caused by the physiological effects of a substance or a general medical condition.
- The patient has experienced mixed episodes, characterized by the simultaneous presence of depressive and manic symptoms.
Pharmacological Treatment
According to the clinical guidelines, the first-line pharmacological treatment for recurrent major depressive disorder with mixed features is a mood stabilizer. Mood stabilizers are medications that work to stabilize mood and reduce the frequency and intensity of mood swings.
The most commonly prescribed mood stabilizers for recurrent major depressive disorder with mixed features include:
- Lithium
- Valproate
- Lamotrigine
The choice of mood stabilizer will depend on the individual patient’s symptoms, medical history, and response to treatment.
Rationale for Pharmacological Treatment
The use of mood stabilizers is indicated in patients with recurrent major depressive disorder with mixed features because these medications have been shown to be effective in reducing the frequency and intensity of mood swings. Mania and hypomania can be particularly challenging to manage, and mood stabilizers can help to prevent these episodes from occurring. Additionally, mood stabilizers can help to improve overall functioning and quality of life.
Non-Pharmacological Treatment
In addition to pharmacological treatment, non-pharmacological treatment modalities are also recommended for patients with recurrent major depressive disorder with mixed features. Non-pharmacological treatment modalities can help to address the cognitive and behavioral symptoms of depression, as well as improve overall functioning and quality of life.
One particularly effective non-pharmacological treatment modality for recurrent major depressive disorder is cognitive-behavioral therapy (CBT). CBT is a type of psychotherapy that focuses on identifying and changing negative thoughts and behaviors. CBT has been shown to be effective in reducing the symptoms of depression and preventing relapse.
Rationale for Non-Pharmacological Treatment
The use of non-pharmacological treatment modalities is important in patients with recurrent major depressive disorder with mixed features because these treatments can help to address the cognitive and behavioral symptoms of depression. Additionally, non-pharmacological treatment modalities can be used in conjunction with pharmacological treatment to provide a comprehensive approach to treatment.
Conclusion
Recurrent major depressive disorder with mixed features is a complex condition that can significantly impact a person’s life. However, there are effective treatments available, including both pharmacological and non-pharmacological modalities. By working with a mental health professional, patients can develop a personalized treatment plan that meets their individual needs and helps them achieve long-term recovery.
