Related Case Studies
Case Study About Mental Health: Reclaiming a Life from the Depths of Depression and Social Isolation
Patient Information
- Age: 34
- Gender: Male
- Background: Software engineer living alone in Mumbai with limited contact with family: an introvert and a high-functioning professional. The history of substance use is unknown.
History or Cause
Ryan (name changed) is a bright but withdrawn software engineer. While he looked calm on the outside and is often used as an example at work, he has been fighting a constant internal battle with sadness, hopelessness, and emotional detachment.
Ryan moved to a hostel away from his parents after school. There, the combination of a new environment, adjustment issues, academic pressure, lack of friends, parental expectation, and loneliness together affected his self-confidence. This was when he got chronic low self-esteem.
After college, he got a good job in the USA and moved to Seattle, where all of his problems and patterns only doubled. Then, with the pandemic coming, his patterns reinforced even more. Soon, his social isolation was followed by skipped meals, irregular sleep patterns, and neglected personal hygiene.
He was laid off from his company in November, and so he returned to India. However, he started living in Mumbai, again alone, to look for a job. The breaking point came in December, when one night he contemplated suicide and started looking for ways online. Thankfully, helpline numbers encouraged him to call the suicide prevention hotline. The call marked the beginning of his journey towards recovery.
Diagnosis
Ryan was referred to Jagruti Rehab by the crisis helpline. Here is what the assessment detailed:
- Initial Screening:
The initial assessment occurred via telehealth, where he cooperated but showed low motivation.
- Clinical Interviews:
We carried out multiple interview rounds non-aggressively, ensuring that he feels heard instead of questioned and judged. We gathered clinical data and found that his depression symptoms had begun at least five years ago. However, the symptoms had worsened in the last six months.
- Assessment Tools:
- PHQ-9 (Patient Health Questionnaire-9): scored 22 (severe depression).
- GAD-7: Anxiety symptoms were present but only mild (score was 8).
- Suicide Severity Rating Scale (SSRS): The SSRS indicated both moderate risk and passive ideations under specific circumstances and one instance of active ideation.
- PHQ-9 (Patient Health Questionnaire-9): scored 22 (severe depression).
- GAD-7: Anxiety symptoms were present but only mild (score was 8).
- Suicide Severity Rating Scale (SSRS): The SSRS indicated both moderate risk and passive ideations under specific circumstances and one instance of active ideation.
- PHQ-9 (Patient Health Questionnaire-9): scored 22 (severe depression).
- GAD-7: Anxiety symptoms were present but only mild (score was 8).
- Suicide Severity Rating Scale (SSRS): The SSRS indicated both moderate risk and passive ideations under specific circumstances and one instance of active ideation.
Final Diagnosis (DSM-5):
- Major Depressive Disorder (MDD), Recurrent, Severe.
- (Comorbid condition) Social Anxiety Disorder.
- Rule out: Avoidant Personality Traits (Evaluation required to clarify avoidant personality traits (2 selected on the rating).
Treatment
Approach:
We chose a combination approach to transform Ryan both psychologically and biologically. We included medication and therapy while placing importance on lifestyle changes for his treatment plan.
Program:
Initial Stabilisation (Weeks 1-2):
- Safety planning, including a contact list for a 24/7 support person.
- Daily virtual contact with the case manager.
- Implemented Behavioural Activation (BA) to assist in combating inactivity.
- Medication
Therapy Components:
- Cognitive Behavioural Therapy (CBT) (Week 3-4) identified the thoughts that bothered him and challenged them with the real facts. (e.g. losing a job, internalising failure). In weekly sessions, he was given homework to track his mood and use the learnt strategies to change thought patterns in real life.
- Social Skills Training (SST) builds social skills using role-played therapy. We worked on eye contact, communication, small talk, and accepting rejection.
- Group Therapy (Week 5 onwards): Ryan found a place to apply his newly learnt social skills and experience the difference of having a friend in life.
- Mindfulness and Meditation (MBSR): Guided meditations and breathing exercises helped him manage anxiety.
Lifestyle and Support Integration:
- Sleep Hygiene Coaching: We helped him set a consistent sleep/wake timer and limit screen exposure before bed.
- Nutritional Counselling: Worked with his poor dietary habits, then enrolled him for basic cooking tutorials via telehealth.
- Physical Activity: Began with 10 minutes of walking in the morning, then progressed to 30 minutes of running each day.
- Peer Support: He was paired with a mentor who had experienced MDD and had recovered to provide support and encouragement.
Improvements / Recovery Timeline:
Week 1-2:
- Ryan was overwhelmed with everything and did not think of recovery. He attended therapy, but he blankly participated in most sessions.
- Medication made him nauseous and fatigued.
- However, he did not miss his daily check-ins and powerfully resisted the impulse to self-harm.
Week 3-4:
- Ryan shared that his suicidal tendency has reduced, and we noticed a little more motivation in him.
- Ryan began journaling. He marked one " good day" in Week 4, which became a significant milestone.
- Ryan started participating more and doing his CBT homework tasks appropriately.
Week 5-6:
- Ryan completed weekly group therapy sessions and shared his ongoing story with the group. He received positive feedback from the group members.
- His physical energy improved, and he started running in the morning instead of walking.
- PHQ-9 =15 (moderate depression).
Week 7-8:
- Ryan shared with our clinic that he stabilised on his medication. He felt better and had clear thoughts.
- He undertook his first social activity in more than a year, which was a coffee with a group member.
- Also, he reached out to his estranged brother by email, which was a worthy personal accomplishment.
Week 9-12:
- Ryan continued with his therapy sessions, where he desired to find a new job.
- He began job searching and experienced success in the process with the help of a job coach.
- PHQ-9: 9 (mild depression). GAD-7: 5 (minimal)
Months 4-6:
- He got a remote software engineering job with a start-up, with flexible hours.
- He started having weekly check-in calls with family.
- Ryan also adopted a rescue dog, which gave him some companionship and routine in his life.
Ryan’s words - My depression hasn’t affected me in a month now; I am still taking medication and going for therapy maintenance. But overall, after a long time, I feel happy.
Our Success
Ryan's journey from being suicidal to becoming financially independent and socially engaged is a result of professional intervention. He now describes his quality of life as "peacefully in progress" while attending monthly therapy check-ins with his therapist.
He now conceptualises mental health like any other chronic condition that needs care, self-awareness, and support. He is no longer described by his diagnosis; instead, he is empowered by his experience.
Family and Community Impact
Ryan's recovery rekindled his connections with his family. He began to reconnect with his parents, who started to understand just how bad his situation was and became active supporters in his recovery. Ryan's brother came to visit him for the first time in four years.
Ryan also quietly became a mental health advocate at his new place of work and encouraged the startup’s HR staff to consider integrating mental health days and employee support lines.
He said, "I used to think I was broken. However, it turns out that I was stuck. The therapy gave me the map, and the people gave me the will to start walking again."
Final Words
Mental health struggles, such as Major Depressive Disorder, often thrive in silence. Ryan's case serves as a reminder of the need for early intervention, compassionate care, and integrated treatment options. When mental health is addressed with the same attention as physical health, with patience, empathy, and science, recovery is possible.
Dr. Amar Shinde, founder of Jagruti Rehab, is a renowned psychiatrist in India with over two decades of experience in mental health, addiction recovery, and neuropsychiatry, dedicated to holistic, compassionate patient care.