Case Analysis: Major Clinical Depression
The plan of intervention selected for Mrs. Lopez is to use individualized and group cognitive behavioral therapy (CBT) to address her presenting problems and to focus on the diagnoses of major depressive disorder and posttraumatic stress syndrome along with opioid dependence. It should be noted that integral to the treatment plan is the use of medical management. Specifically, Mrs. Lopez will be treated with risperdal and fluoxetine HCL (prozac). This pharmacotherapy is seen by many as necessary to facilitate a reduction in depressive symptomology and the corresponding anxiety formation that is often observed among patients with major clinical depression (MacGillivray, Arroll, Hatcher, Ogston, Reid, Sullivan, Williams, & Crombie, 2003).
However, it should be noted that there is limited evidence of the relative efficacy of these pharmaceutical treatments via antidepressant therapy. MacGillivray, et al (2003) reported that patients receiving a tricyclic antidepressant often tend to withdraw from treatment prematurely and to ultimately go off a medication regimen because of side effects. Thus, while Mrs. Lopez will be given pharmacotherapy as part of her treatment regimen, it is essential to offer targeted CBT in order to ameliorate many of the inadequate cognitive schema that continue to distort her perceptions and lead to risk-taking behaviors.
The plan of intervention therefore focuses on a course of CBT known as prolonged exposure that entails education about common reactions to trauma, relaxation training, imaginal reliving of the trauma memory, exposure to trauma reminders, and cognitive restructuring (Jaycox, Zoellner, & Foa, 2002). The treatment will focus on educating Mrs. Lopez about the events which triggered her depression and PTSD and emphasize the development through positive reinforcement of appropriate schemas which will permit Mrs. Lopez to avoid relapse. The ...