Related Case Studies
Persistent Depressive Disorder Case Study: See How Daily Support Helped
Patient Information:
- Age: 32
- Gender: Female
- Background: Office manager, lives in a suburban area with her partner and a young child.
- Personal History: Avanti was hard-working and caring throughout her life and had always done well at work and with her family obligations. However, this was the first time Avanti felt increasingly distant and more persistent in sadness than ever, overwhelmed by the daily obligations of life. Avanti was diagnosed with mild depressive symptoms in her late teens. However, she had never sought help for it.
History or Cause:
Avanti's case of persistent depressive disorder (PDD), or dysthymia, started to present itself in her early twenties. At that time, it was mild and manageable. However, the severity of the disorder increased in her late twenties (only becoming more pronounced after she gave birth to her child). While postpartum depression was a contributing factor to her depression, it went unattended for several years before that.
In the past two years, Avanti's symptoms had begun to worsen to the point where she could not find enjoyment in what she had once enjoyed, including spending time with family and engaging in hobbies. Even sleep patterns were distorted, as she would at times sleep more than 12 or more hours; other times, she did not sleep at all. Avanti described herself as irritable, guilty, and fatigued regularly.
Avanti's situation worsened from the time her partner observed the increasing tension in the relationship, along with her emotional experience being clear in her poor job performance, resulting in avoidance of social events and activities she previously was interested in. Avanti removed herself further and further from social connections, concomitantly removing herself from daily activities of concern and obligations of work.
Diagnosis:
After an extended number of visits with a clinical psychologist, Avanti was diagnosed with Persistent Depressive Disorder (PDD), also known as dysthymia, which indicates an extended experience of low-level depression that has persisted for a minimum of two years. The diagnosis process consisted of:
- Clinical Interviews: After numerous detailed, extensive conversations with her therapist, Avanti was able, in a therapeutic setting, was able to elaborate on her symptoms and her history. From her history, a sizeable amount of evidence of her experiences of depression occurred, historically, based on years of adulthood.
- Self-Report Questionnaires: Avanti completed numerous diagnostic self-report questionnaires to obtain a measure of depressive symptoms. These questionnaires included the Beck Depression Inventory (BDI) and the Patient Health Questionnaire (PHQ-9), both of which detailed her symptoms and suggested she experienced depression over the years. The questionnaires consistently demonstrated that Avanti had symptoms of depression.
- Exclusion of Other Conditions: Upon completing the diagnostic process, the PPD diagnosis was confirmed based on the previous exclusion of other psychiatric diagnoses, particularly Major Depressive Disorder (MDD) and Bipolar Disorder. The clinical psychologist had also, as part of the assessment, verified that substance abuse and medical conditions were not causative or relevant to Avanti's symptoms.
At this point in the process, it was accepted/acknowledged that Avanti's persistent depressive disorder had been for more than two years! It was a significant time.
Approach:
Model of treatment focused on bringing Avanti a step closer to healing from chronic depression and restoring her lost balance in life and health, in this case, to PDD; hence, the treatment involved a multi-modal display of therapeutic modalities, lifestyle modifications, and social support systems.
Program:
The treatment plan was structured in several phases:
- Initial Assessment and Stabilisation:
Avanti commenced an extensive psychological assessment of her daily lifestyle and mental health. This phase of assessment helped her therapist understand the potential contributing factors underlying the positive/negative cycles of her depression, including stressors associated with family life and occupational strains. For example, the therapist encouraged Avanti to start her journaling entry every day to map her mood into a journal-to get an idea of her depression cycles. - Cognitive Behavioural Therapy (CBT):
CBT was the basic form of treatment and also one that explored the negative thoughts for her while assisting Avanti in facing those cognitive distortions. The cognitive processing component of CBT assisted Avanti in attempting to reframe her guilt and worthlessness with more reasonable and compassionate thoughts. The skills taught in CBT also involve a more analytical and focused perspective. Practicing problem-solving and encouraging sharing, referring to practical routines in the future to manage her ongoing stress. - Interpersonal Therapy (IPT):
IPT sought to focus on improving Avanti's social connections with others, and particularly was directed toward better interacting with her partner and other close family members. With IPT, Avanti worked on issues related to her communication skills and took steps to overcome her emotional isolation - Lifestyle Modifications:
A nutritionist had been consulted to draw up an eating plan that optimally suited Avanti's diet since nutrition has a role to play in overcoming depression. Avanti also had physical activity included in her routine with daily walks, yoga, and meditation. The lifestyle changes were meant to stabilise Avanti’s mood, lessen physical aspects of depression (i.e., fatigue), and offer Avanti a sense of accomplishment. - Support Network:
Avanti’s therapist encouraged her to formulate a daily support system, help Avanti to maintain her friendships and family connections more frequently, and connect to an online support group for others who have experienced chronic depression. The social activity helps Avanti feel connected and provides engagement and decreases her inclination to isolate.
Medical Treatments (Optional):
While therapy was the primary focus of Avanti’s treatment, her psychiatrist prescribed an SSRI (Selective Serotonin Reuptake Inhibitor) to support mood stabilisation. Avanti was monitored monthly, being assessed for medication efficacy and adjusted as needed with dosages. However, in the beginning, she was experiencing side effects (nausea and insomnia) that were troubling; these gradually abated once Avanti’s body acclimatised to the medication.
Therapy Sessions:
Avanti engaged in one-on-one therapy sessions every week, encompassing CBT and IPT. The sessions equipped her to address her depressive thoughts, communicate more directly with her family members, and cope more effectively with her stressors. In addition, Avanti participated in a bi-weekly group therapy session that offered her peers who were dually facing similar issues. The group provided validation and a sense of connection and let Avanti know that she was not in the fight alone.
Improvements/Recovery Timeline:
- Week 1-2:
Avanti's first two weeks included a lot of transitioning into the new routine of therapy and medicine. She experienced early side effects from her medicines, but she continued to attend therapy. This time was not easy for Avanti, and she was still in the early process of acceptance and recognition of her depressive condition. But, for the first time, she started journaling her thoughts, which was her first step to begin to deal with and acknowledge her negative self-talk. - Week 3-4:
By now, Avanti was experiencing small but notable improvements, with her mood being a little more positive and with more energy. Interactions with family were less strained, and she was beginning to utilise some of the communication strategies she learnt in IPT. In the CBT sessions, she started to notice some of her automatic thinking and to challenge some of her most stubbornly negative thoughts. - Week 5-8:
Several months into therapy, Avanti had greater reductions in her depression. She was waking up earlier, and she had more energy throughout the day. By now, her mood was much more stable, and she experienced a sense of accomplishment after completing things around the house or at work. Being part of the group therapy sessions gave Avanti a sense of connection, and she was beginning to share more with the support group. - Week 9-12:
Avanti’s progress continued in a steady manner, even as she was adjusting her daily support system and making lifestyle changes. She was able to spend more quality time with her family, which also improved her relationship with her partner. Her performance at work improved, she felt more engaged with her work-related responsibilities, and she moved into the role of an advocate for mental illness, sharing her experiences with others dealing with similar concerns.
Our Success:
Impact on Patient’s Life:
Avanti's recovery made a distinct change in her life. She gained a sense of agency and a sense of purpose that helped her to overcome the emotional numbness she had endured for the previous several years. She was able to enjoy her family, engage in some of the things she had enjoyed pre-illness, and feel emotionally available and invested in her relationships. She returned to work with renewed focus and passion and felt a sense of empowerment from the tools she had learnt while participating in therapy.
Family and Community:
Avanti's recovery impacted her well-being, but also had the added benefit of extending to her family and her social circles as well. Her partner, who had been struggling with stigma around Avanti's depression and the stress of the by-products of depression, was hopeful to see a light at the end of the tunnel and that Avanti was improving. This brought the couple closer together with Avanti's increased emotional availability. Additionally, being involved in a support group provided a means for Avanti to connect and identify with others and share her journey, as well as provide encouragement to others in a profession where they may see similar experiences.
Future Steps:
To ensure her continued progress, Avanti plans to attend bi-weekly therapy sessions (individual) and monthly support groups and has embraced the lifestyle changes she made during treatment (e.g. exercise, nutrition). Avanti’s story provides evidence that with ongoing support and an individual approach to treatment, a person can recover from even the most entrenched forms of depression.
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.