Case: Major Depressive Disorder in a College Student

Condition: Major Depressive Disorder (MDD)

Risk Factors:

• Biological: A family history of depression suggests a potential genetic predisposition.
• Psychological: Difficulty coping with academic stress and social isolation common during the first year of college.
• Social: Recent break-up with a romantic partner and limited social network at college.

Pathophysiology: The exact cause of MDD is unknown, but it likely involves a complex interplay of factors:

• Neurotransmitters: Imbalances in brain chemicals like serotonin, norepinephrine, and dopamine may contribute to mood regulation issues.
• Brain Structure and Function: Studies suggest changes in certain brain regions associated with mood regulation, motivation, and pleasure.
• Stress Hormones: Chronic stress can elevate cortisol levels, disrupting neurotransmitter function and impacting mood.

Clinical Manifestations:

• Depressed mood: Feeling down, sad, or hopeless most of the day, nearly every day.
• Loss of interest or pleasure in activities once enjoyed.
• Significant changes in appetite or weight (weight loss or gain).
• Sleep disturbances (insomnia or hypersomnia).
• Psychomotor agitation or retardation (feeling restless or slowed down).
• Loss of energy or fatigue.
• Feelings of worthlessness or guilt.
• Difficulty concentrating or making decisions.
• Recurrent thoughts of death or suicide.

Differential Diagnoses:

• Adjustment Disorder with Depressed Mood: This can occur due to a stressor but symptoms are less severe and resolve within 6 months of the stressor ending.
• Bipolar Disorder: While depression is a core symptom, bipolar disorder also involves episodes of mania or hypomania (elevated mood and energy).
• Substance Abuse Disorder: Depression and substance abuse often co-occur. Using substances may be an attempt to self-medicate depressive symptoms.
• Medical Conditions: Certain medical conditions like thyroid problems or chronic pain can mimic symptoms of depression.

Additional Considerations:

• The patient’s age (college student) is a relevant factor as depression is a common mental health concern in this population.
• The duration and severity of symptoms will be crucial for diagnosis and treatment planning.
• Suicidal ideation is a serious concern and requires immediate assessment and intervention.

Importance of Early Diagnosis and Treatment:

Early identification and intervention are essential for effective management of MDD. With proper treatment, including therapy and medication if needed, individuals with MDD can experience significant improvement in their symptoms and overall well-being.