Case Study

Major Depressive Disorder & Active Suicidal Thoughts

Presenting Problem
AM, a 29-year-old female PhD scholar, seeks psychological support for severe anxiety and
depressive symptoms, along with physical symptoms such as difficulty in breathing, elevated
heartbeat, and a sensation of a lump in her throat. She reports feeling sad, loss of interest in
activities that she previously enjoyed, and an inability to manage daily responsibilities. AM
also discloses that she has active suicidal thoughts and has attempted suicide previously.
Additionally, she exhibits body image concerns, disturbed sleep, appetite contributing to her
inability to cope effectively with her daily tasks.

Demographic Details
• Name: AM
• Age: 29
• Sex: Female

• Educational Qualification: PhD Scholar

• Marital Status: Single
• Employment Status: Employed as a PhD project employee
• Family Type: Joint Family
Psychosocial History
AM is part of a joint family with a history of mental health challenges, including depression,
anxiety, and OCD. She was initially diagnosed with depression by a psychiatrist in 2020 and
was prescribed medication. However, she discontinued the medication on her own without
consulting her psychiatrist. She reports experiencing depressive symptoms and anxiety from a
young age, which were never addressed. AM’s current stressors include family dynamics,
toxic relationships within her work environment, and PhD-related academic pressures.
Mental Status
• Appearance: Maintained appropriate dress and grooming.
• Behavior: Noted anxiety, with visible signs such as shaking legs.
• Speech: Clear but was hesitant, with a tendency to look down during conversation.
• Mood: Low, with a gloomy affect that was consistent with her mood.
• Thought Process: Evidence of suicidal ideation.
 • Perception: Normal.
• Insight and Judgment: Present; she was aware of her condition and displayed
adequate judgment.
History of Presenting Illness (HOPI)
AM’s depressive and anxiety symptoms began around eight weeks before seeking help, with
an escalation in suicidal thoughts. Previous occurrences of depressive symptoms were
observed during her teenage years. Current stressors include negative experiences with her
academic supervisor, a toxic workplace, and a sense of isolation due to living away from
family. Factors that extend her mental health challenges include her family’s lack of
emotional support, a stressful academic environment, and grandparents who have been
emotionally unsupportive. Additionally, family predispositions for depression, anxiety, and
OCD contribute to her vulnerability.
Family History
• Mother: Diagnosed with depression and anxiety, currently on medication.
• Grandfather: Diagnosed with OCD, receiving treatment.
• Father: Exhibits signs of anxiety and struggles with managing his symptoms.
Assessment
Based on AM's presentation and psychosocial history, she displays symptoms that aligning
with Major Depressive Disorder (MDD), with elements of trauma and anxiety. Her ongoing
depressive and anxiety symptoms, combined with environmental stressors and predisposition
to mental health challenges, has significantly impacted her mental state and daily functioning.
AM's self-harm thoughts and history of suicidal ideation necessitate close monitoring and
safety planning.
Intervention Plan and Goals
AM’s therapeutic intervention commenced on March 8, 2024, with the primary objective of
addressing her depressive and suicidal symptoms, anxiety, and body image concerns. The
following strategies were applied:
1. Safety Planning and Psychoeducation: The initial sessions focused on safety,
discussing warning signs, and providing crisis resources like helpline numbers. AM
was encouraged to communicate with her support network during crises.
2. Therapeutic Interventions:
o Cognitive Behavioural Therapy (CBT): Addresses AM’s cognitive
distortions related to learned helplessness and disastrous thinking patterns.
o Dialectical Behavior Therapy (DBT): Employs techniques in distress
tolerance and emotional regulation to manage anxiety and suicidal ideation.
 o Acceptance and Commitment Therapy (ACT): Supported her in accepting
and managing distress without letting it disrupt her values and long-term
goals.
o Mindfulness Techniques: Introduced to reduce anxiety and promote self-
awareness.
3. Referral to Psychiatrist: Medication was resumed under psychiatric guidance to
support symptom management.
4. Body Image Concerns: CBT techniques helped address body image issues by
reshaping her self-perception and coping strategies.
5. Trauma De-Escalation: Sessions were devoted to addressing childhood trauma
associated with family dynamics and relationships.
6. Psychoeducation for Parents: AM’s parents were informed about her mental health
challenges and were provided with strategies to support her recovery effectively.
7. ECT Recommendation: Advanced psychotherapeutic interventions, such as
electroconvulsive therapy (ECT), was suggested by her psychiatrist due to the severity
of her depressive symptoms.
8. Daily Routine Development: Assisted AM in structuring her day to regain control
over her responsibilities and time management.
Diagnostic Impressions
According to the DSM-IV, AM’s symptoms are indicative of Major Depressive Disorder
(MDD), potentially worsened by generalized anxiety and trauma-related stress. Her suicidal
ideation and self-harm tendencies reflect the urgent need for sustained intervention. She also
presents risk factors for PTSD due to historical trauma and continuous exposure to stressors.
Skills and Challenge Areas of Session
AM engages well in sessions, showing willingness to discuss her thoughts and emotions.
Challenges included AM's initial resistance to discussing traumatic experiences and moments
of withdrawal when discussing family issues.
Conclusion
AM’s case highlights the complexity of managing MDD in individuals with compounded
environmental and familial stressors. Through CBT, DBT, ACT, and mindfulness, AM’s
mental health showed marked improvement over the course of therapy. From March 2024 to
September 2024, AM's depression, anxiety, and self-harm tendencies were effectively
managed, promoting resilience and better coping mechanisms. Continued support and
monitoring are advised to prevent recurrence, with family involvement being a crucial aspect
of her long-term recovery.
References
• American Psychiatric Association. (DSM-IV). Diagnostic and Statistical Manual of
Mental Disorders (Fourth Edition). Washington, D.C.: American Psychiatric
Association, 1994.
• Charles, D. R., & Charles, M. (2006). Sibling Loss and Attachment Style: An
Exploratory Study. Psychoanalytic Psychology, 23, 72-90.
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