Depression
23 year old female final year MBBS student with 1 year history of illness
A 23 year old female accompanied by her mother came to my clinic at Podiyadi, Thiruvalla in May 2019, complaining of low mood. She was studying MBBS final year in a medical college in Pathanamthitta district of Kerala.
Her complaints started 1 year back when she was studying 3rd year MBBS. She without any reason began to experience low mood, which she could experience as having a different quality and intensity to the usual sadness which she had experience in the past and this low mood was present on most of the time a day, most of the days a week. Along with the low mood, she also noticed that she is getting mentally and physically exhausted and tired very easily even after a light mental or physical exertion. She would then have to lie down and take rest; but even after taking rest she wouldn’t feel refreshed or energetic. She also began to lose interest in activities which previously was pleasurable to her, like she now didn’t have much interest in watching TV or seeing movies or studying or going out with friends. Slowly she began to lose interest in talking even with her own family members. Most of the time she was sitting locked inside her own room, just lying down and crying sometimes.She began to get sad & irritated & angry when others would ask why she is behaving in such a strange manner.
Back at college, she became less interactive with her colleagues, most of the time confined to herself. She lost confidence in herself to such an extent that she was finding it difficult to maintain eye to eye contact while interacting with others. During the class she couldn’t maintain concentration and was accused of day dreaming by her teachers who would now scold her for being lazy and disinterested. She found presenting seminars and symposiums extremely difficult- would become extremely nervous, anxious and frightened and break down in tears in between. So, she began to make up excuses to skip it. She couldn’t concentrate well while studying, feeling quickly exhausted even after a slight mental effort and during theory exams she complained of forgetfulness and couldn’t remember what she had learned. During practical exams she developed extreme nervousness and social anxiety and couldn’t perform well. Her performance in college dipped and she failed in 3rd year MBBS exams.
She began to worry about her present condition and worried how she may end up in the future. She felt that others are not understanding and helping her. She began to think her life has become worthless and hopeless and it was now better for her to die. She once planned to end her life by committing suicide but didn’t have thecourage to execute it. Her sleep was disturbed and appetite was now low and she began to lose weight. Her self-care was affected. Usually she used to take bath twice a day. But now she wouldn’t care to take bath even after 3 or 4 days.
With these complaints she was taken to a psychiatrist and was given medication. But she got extremely drowsy on these and discontinued treatment. Then she was taken to another psychiatrist and again put on another set of medications, but now she complained that her anxiety symptoms increased very much. So, at 23 years of age, 1year after the illness began, she was brought to me for consultation.
On examination- Patient was moderately built and nourished, fully conscious & cooperative, rapport was established. Psychomotor activity was decreased, Talk was decreased in amount, tone & tempo, reaction time was increased, prosody was maintained, relevant & coherent. Examination of her Thought showed that she had retardation of thinking and depressive cognitions- ideas of helplessness, worthlessness and hopelessness. No active suicidal ideas although death wishes were present. Mood was anxious & depressed. Affect was decreased in range and reactivity, appropriate but slightly labile. No perceptual abnormalities like hallucinations were noted. Cognitive functions showed decreased attention and concentration with normal intelligence, memory and abstractability and intact judgement and good insight.
Diagnosis of Depressive episode – severe was made.
Patient and relative were psychoeducated regarding the illness, a definitive management plan was worked out with the client and relative. She was started on Pharmacotherapy (Medicines) – antidepressants and Psychotherapy (CBT). After 4 weeks – up titration of medicines to therapeutic level & 4 CBT sessions, 100% improvement was attained and maintained. No side effects to medicines were reported. She passed 4th year MBBS with good marks & completed her house surgency too. She still remains symptom free and happy, back to her normal self, now practicing as a doctor.
Self-Assessment
