Clinical Case Summary: Ms. Z is a 28-year-old assistant store manager presenting with symptoms of sadness, fatigue, oversleeping, difficulty getting out of bed, difficulty concentrating, and guilt following a recent breakup with her boyfriend. She has a history of failed romantic relationships, expresses low self-esteem related to her perceived inability to find a significant other, and reports late arrivals at work due to oversleeping. Although she denies suicidal ideation, she has become tearful in front of clients. Ms. Z spends long hours in bed but does not report significant changes in appetite or weight. She exhibits some brightening when discussing positive aspects of her life.

Subjective Data:

1. Recent breakup with boyfriend.
2. History of failed romantic relationships.
3. Difficulty getting out of bed.
4. Fatigue despite long hours of sleep.
5. Difficulty concentrating.
6. Feelings of guilt and inadequacy.
7. Isolation from friends.
8. Tearfulness at work.
9. Brightening when discussing positive aspects.

Objective Data:

1. Late arrivals at work.
2. Spending over 12 hours in bed.
3. No significant changes in appetite or weight.
4. Denies suicidal ideation.

Primary Diagnosis: Major Depressive Disorder, Recurrent (ICD-10: F33.0)

• Ms. Z exhibits several symptoms consistent with Major Depressive Disorder, including sadness, fatigue, oversleeping, difficulty concentrating, guilt, and impaired social functioning. These symptoms have persisted for at least two weeks, indicating a recurrent episode.

Differential Diagnoses:

1. Persistent Depressive Disorder (Dysthymia) (ICD-10: F34.1)

• Although the symptoms meet criteria for Major Depressive Disorder, it’s important to consider Persistent Depressive Disorder due to Ms. Z’s history of failed relationships and prolonged duration of depressive symptoms.

2. Adjustment Disorder with Depressed Mood (ICD-10: F43.21)

• Given the recent breakup and the impact on Ms. Z’s emotional well-being, an adjustment disorder should be considered. However, the duration and severity of her symptoms may not entirely fit this diagnosis.

Pharmacological Treatment: Considering the severity of Ms. Z’s symptoms, especially the impact on her daily functioning and the possibility of a recurrent depressive episode, an antidepressant medication may be appropriate. Selective Serotonin Reuptake Inhibitors (SSRIs), such as Sertraline (Zoloft), may be considered as a first-line treatment (based on clinical guidelines) to alleviate her depressive symptoms.

Non-Pharmacological Treatment:

1. Cognitive-Behavioral Therapy (CBT): CBT is recommended as a non-pharmacological treatment for depression. It can help Ms. Z address negative thought patterns, low self-esteem, and provide coping strategies for managing her breakup and relationship difficulties.
2. Interpersonal Therapy (IPT): IPT may be beneficial for Ms. Z given her focus on relationship issues. It can help her improve her interpersonal skills and cope with the loss of her relationship.

Health Promotion Intervention: To promote overall well-being, Ms. Z could benefit from a holistic approach. One suitable health promotion intervention could be:

3. Physical Activity and Exercise: Encouraging Ms. Z to engage in regular physical activity can help boost her mood, alleviate fatigue, and improve her overall health. She can start with a manageable exercise routine and gradually increase intensity over time.

In summary, Ms. Z presents with symptoms of Major Depressive Disorder, recurrent, but it’s important to consider differential diagnoses and provide comprehensive treatment. A combination of pharmacological (e.g., SSRIs) and non-pharmacological interventions (e.g., CBT, IPT) is recommended, along with a health promotion intervention focused on physical activity to enhance her well-being. It’s essential to monitor her progress and adjust the treatment plan as needed.