Major Depression Disorder: Causes, Symptoms, and Treatment

Patient medical review 

Major depression remains among the leading mental illnesses that adversely affect patient lifestyles and health. At 69 years, the patient has undergone recurrent depressive episodes for the past 40 years. From their medical history, the patient has responded well to treatment as well as inter-episode recovery until the last five years. The patient’s condition, however, in the last 5 years has included a relapse in on venlafaxine 225 mg after he had shown a good response to the drug. The relapse has seen caregivers administer various medication combinations as therapies as well as integrate consultative options with other psychiatrists across variously distinguished centers. Based on patient’s consent, the medication has included various trial and controversial treatment combination that saw the administration of Monoamine Oxidase Inhibitor (MAOI) as well as other depressants that include TCA phenelzine all medication that proved ineffective. Other observations are based on the patient’s family history when it comes to having had mental health-related problems. 

Ethnic Aspects of Depression 

The outcome of family background indicates that the patient’s family had a history with mentally related cases of depression. Several family members reported cases of degree depression with no reported cases of suicide. From a medical perspective, there is a likely connection between the recurrent depression cases in the patient’s family to his ailment. Despite existing no sufficient research confirming the hereditary aspect of depression, studies have alluded to the genetic link between the serotonin transporter genes with depression (Parera et al., 2016). The presence of long and shorter genetic material in patients along hereditary lines has been observed to be responsible for depression; even though a grey area, genetic relation has remained a key aspect when it comes to mental illnesses such as depression. Since the patient’s first degree relatives had reported cases of depression, the likelihood that his case is ethnically-based remains high. 

Genetic factors are a significant aspect to consider when planning patient recovery therapy. According to Parera et al. (2016) indicate that antidepressant therapies for mental illnesses such as major depression remain dependent on patient genetic makeup or ethnicity. According to Reyes-Barron et al. (2016) SSRIs remains one such approach that should consider close reexamination of patient genetic makeup with significant emphasis on how polymorphism of the serotonin gene affects the uptake of various antidepressant inhibitor drugs. The studies have indicated that the response of long serotonin genes and short serotonin genes to drugs may differ from one ethnic group to another making it important that before administering such antidepressant therapies, an elaborate pharmacogenomics finding has to be conducted (Reyes-Barron et al., 2016). The purpose of such an elaborate procedure should be to ensure that the antidepressant therapy proposed for the patient remains aligned with their ethnic response when it comes to the administration of medication. However, since the patient’s family history remains supportive of the fact that the depression causing gene might be a reason for the persistent depressive episodes, the patient treatment program should consider a preferential treatment regime. 

The patient’s situation over the last two years has worsened in severity with medical findings rating him at a 9/10 severity with his family concerned that the patient is likely giving up on possible medication. The patient's care team must look into the possibility of the case being a resistant genetic depression that has managed to disguise other problems. The approach should accompany a completely elaborate endocrine, neurological, and pharmacogenomics evaluation to ensure that the care team is in a position to identify any possible aspects of the patient’s medical history that might have been missed during initial evaluations and diagnoses. As such, the case would warrant a referral to pharmacogenomics testing for the purpose of evaluating the patient’s genetic factors for purposes of evaluating how his ethnic and family backgrounds might be a factor to his resistant depression. 

PART II 

Questions to the Patient 

If the patient were to be in my office these are the questions I would ask them 

How were they feeling about their situation? 

The answers to this question allow you assess the patient’s opinion about their condition, patient’s view on their health remains critical in planning any treatment approach. 

Would they consider any form of treatment that is considered controversial or un-tested? 

Patient approval or consent on treatment plans helps when it comes to untested and controversial methods of treatment. 

Have there been conditions of major depression in their family, and how were they managed? 

The question helps to further expound on family history in cases of hereditary disorders as well as allow patients contextualize their condition. 

From the family members, I would need to have a session with the patient’s wife, siblings or parents. 

Wife 

I would ask the wife how the patient responded to previous treatment measures, and if as a family they would recommend any other trial measures on the patient. The questions help ascertain the family ability and position on any further interventions for purposes of approval/consent. 

Parents or Siblings 

I would ask them of the patient medical history and the prevalence of major depression disorder in their family. They are the patient’s immediate family and would provide a comprehensive history on their family and of the patient’s early life. 

Physical and Diagnostic Tests 

The diagnostic tests performed on the patient would include 

Blood testing/sampling for substance abuse and genotyping analysis 

CT scan and MRI for brain illnesses imaging for tumors 

Electrocardiogram (ECG) for heart problem diagnosis 

Electroencephalogram (EEG) for brain electrical activity 

Differential Diagnosis 

Mood disorders due to other conditions; other medical conditions such as sclerosis or cardiovascular diseases can lead to depression leading to mood disturbances. 

Substance abuse or Bipolar disorder : abuse of prescription medication or narcotics can lead to patients experiencing similar mood disorders. Cocaine or opioid abuse in bipolar patients can induce depressive episodes and diagnosis. 

Attention deficit disorder since patients suffering from the condition easily gets distracted and frustrated. 

References 

Perera, T., George, M. S., Grammer, G., Janicak, P. G., Pascual-Leone, A., & Wirecki, T. S. (2016). The clinical TMS society consensus review and treatment recommendations for TMS therapy for major depressive disorder.  Brain stimulation ,  9 (3), 336-346. 

Reyes-Barron, C., Tonarelli, S., Delozier, A., Briones, D. F., Su, B. B., & Rubin, L. P. (2016). Pharmacogenetics of antidepressants, a review of significant genetic variants in different populations.  Clin Depress ,  2 (2), 1-10. 

Woods, D. L., Mentes, J. C., Cadogan, M., & Phillips, L. R. (2017). Aging, Genetic Variations, and Ethnopharmacology: Building Cultural Competence Through Awareness of Drug Responses in Ethnic Minority Elders.  Journal of Transcultural Nursing ,  28 (1), 56-62.