Paper Sample on Unraveling Amanda's Struggle: A Deep Dive into Depression, Coping, and Hope

Relevant Medical History

Amanda, a mother of one daughter, has previously been diagnosed with clinical depression. Amanda first sought treatment for depression following the birth of her firstborn daughter, Marya. She recalls that she first felt depressed after realizing her pregnancy with Marya, and the depression worsened after she gave birth to her daughter. During her first trimester, she recalls feeling sad, and tired, having difficulty sleeping, dwindled energy, lethargy, and frequent periods of crying at night and during the day without a clear cause. Despite her exhaustion, she reports that she could not sleep at night. She recollects that she felt like she had lost control of her life. During her routine visits to her gynecologist, the practitioner prescribed 20mg of Pixal, which she continued taking for three months. However, she discontinued the use of the medication, as she did not feel it was helping her. Her feeling was that she did not feel the effect of the medication and had no impact on her depression. Moreover, she does not like taking prescriptions. She did not report any other episode of depression in her life.

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Presenting Problem

The client in this case assessment is a 37 African American woman who has presented with symptoms of depression. Amanda reports that she feels sad all the time, tired, has difficulty sleeping, dwindled energy, and cries at night and during the day without a clear cause. When she sleeps, her sleep is disturbed, and for only a few hours, she takes several hours to fall asleep. On some nights, she does not sleep at all despite being exhausted. She spends time worrying and thinking that she is not a good mother and feels like a burden to her husband, Bill. She recollects her family of origin and her unsatisfactory relationship with her birth mother.

Amanda reports that her depression seems to have worsened since she gave birth to her daughter eleven months ago. Her initial statements in the first interview were that she felt all right but after a short pause. She described constantly feeling watched all the time by everyone. She did not disclose any thoughts or ideas of committing suicide at any cost. She, however, felt like she was running away from her problems but was aware that she could not do that. Amanda recognizes that her issues are influencing and affecting her daily life activities in several ways. Firstly, her relationship with her husband and her daughter is affected. Secondly, her relationship with her family has been hit, as she is not able to attend family events like Thanksgiving and Sunday dinners. Amanda is unable to work out of the confines of her home, resulting in financial problems in her household. She is cognitive of her reduced self-worth, she is not the person she would love to be, and she adds that the depression has ruined her life.

Neurological History

Amanda's medical records do not indicate any significant issues during her birth and the prenatal period. She also does not recall any alarming events like head injuries or trauma during this period. Her developmental milestones are without neurological problems. Amanda grew up in a family of four, comprised of her younger sister, younger brother, her father and mother, Miriam, Dave, Alisson, and Gregory, respectively. She recalls her childhood being chaotic and unstable. Her mother was an alcoholic who argued and fought with her father frequently. When Amanda was only twelve years old, her mother left their home, leaving them with their dad. She often talked to them on the phone but made no effort to make physical contact with them for five years.

During Alisson's absence, Gregory raised Amanda and her siblings alone. During this period, Amanda recalls that her father always looked hurt and quiet; he did not share his problems with anyone. Since Amanda was a teen in this period, she was responsible for making meals for her siblings and other household chores. Her relatives from her father's side also helped by looking in on the kids when Gregory was working long hours. He always provided what his kids needed. She recalls feeling responsible for her siblings. Her fathers were always there in the evening to look into their homework and other chores. Amanda felt distant from her father as they did talk much. The whole family dealt with the entire situation of her mother by not talking about it, resulting in emotionally distant relationships. Amanda talked with her siblings about her mother's abandonment; they looked at the situation from their own perspective. She was angry and was still angry with her mother. She feels that she lacks emotional support and communication from her family.

Even after her mother's return to the family, Amanda still held her angry emotions, which led to her acting out. At 18 years old, Amanda became pregnant by an irresponsible and unstable man who was not present in her pregnancy. She chose to have an abortion. Amanda has had other relationships with men; however, she describes them as being corrupt and unfulfilling. She later met her husband, Bill, who was caring and loving. He is a hard worker and a provider, and she is happy that she married him. Amanda resents her emotionally unsupportive and unstable childhood. Amanda has led to her having unresolved anger towards her mother; this feeling resurfaces in their current relationship. Amanda now lives with her husband of five years and her daughter Marya. Bill owns his own roofing business, where he puts in long hours to provide for his family. Amanda stays home with their daughter all day long.

Amanda feels frustrated that her husband works a lot and seldom has time for them together. She has difficulty getting a babysitter, and her mother always has excuses not to babysit for her. The friends that she has babysat for before are also not willing to reciprocate. She feels taken advantage of by her friends. Her husband had hurt his back recently is working even longer hours to try to catch up with the bills, and it has strained their relationship further. Amanda has the memory of being ill during her pregnancy with Marya. She feels that the pregnancy was unplanned since she was on birth control pills during her conception. She is a present mom, more than her mother was to her, she plans picnics with her child but is never that present to enjoy the moment. Because of this emotional detachment, she second-guesses her ability as a good mom. In her current state of depression, she feels guilty of cheating her children for the time they deserve from her.

Amanda is concerned about her relationship with her mother. She feels that she wants to make amends. Alisson no longer has a drinking problem, but they still argue with Amanda. She feels that her mother was never there for her growing up and is still not there for her now. She is, however, feeling guilty about her continued resentment towards her mother. Amanda is in touch with her family, despite their unresolved family arguments and conflicts. The sister, Miriam, is married, and Dave still lives with his parents. Dave has a child that he fails to spend time with, prompting Amanda to step in in a caretaker role every so often. Recently, Amanda has had two events that are haunting her. She went on a date instead of going to visit her grandmother; she later passed on that night. Her father asked her to run an errand for her; she refused to do it. Her father had a heart attack when running that errand. She blames herself for these two outcomes. This guilt has prompted us to do things for people despite not being happy for fear that something terrible will happen.

Amanda has had a brief history with drugs as a teenager. She experimented with cigarettes, alcohol, and marijuana but lost interest in them eventually. Other than an occasional beer at an event, she denies any other drug use. Amanda admits that she has had problems with her weight and obtains comfort from foods high in fat content. Amanda does not have prior psychiatric treatment. Other than heavy menstrual flow lasting up to nine days and the pregnancy when she was on a pill, she lacked any other medical conditions at the time of this treatment. This psychiatrist prescribed 50mg of Zoloft to treat her depression. She feels that the medication has helped decrease her depression despite the taste it leaves in her mouth. According to her family history, Amanda recalls that one of her maternal aunts was diagnosed with bipolar disorder and another with a mental illness. Her mother always looks unhappy, and she feels that she could be suffering from her own form of depression.

Amanda's husband has recognized her problem. He is willing to help and is in support of her seeking counseling and treatment. She is concerned that her depression will ruin her marriage if it continues for an extended period. Her sister, some friends, and her husband are her primary support, though she does not disclose everything to them. Her brother recognized that she was always angry when dealing with their mother. The main stressors identified by Amanda are; a lack of financial independence, long hours spent caring for her child, and a lack of emotional reciprocity with her mother. Amanda stated that she has two harmful coping mechanisms. The first one is smoking; she can smoke up to ten cigarettes a day, which she indicated that she would like to stop despite being a way of relieving her stress. The second negative coping mechanism is overeating; she also wants to stop stress eating.

One of her positive coping mechanisms is exercising; she feels better mentally and physically after spending forty hours exercising. She also shares her therapy home assignment with some of her girlfriends, some of whom have had depression before. The third positive coping mechanism is seeking therapy and sharing her problems with a stranger. Loss of confidence in herself has left her at the mercy of others. She has depended on other people's reactions to feeling important. This feeling of dissatisfaction has led to her seeking therapy. The most appropriate personality assessment instrument for Amanda's presenting problem would be the Diagnostic and Statistical Manual, DSM-IV-TR. The DSM-IV-TR brings out the following characteristics about Amanda; loss of interest in most activities, variations in sleep habits, weight and eating disorders, and psychomotor activity. She is experiencing a loss of her capacity to make decisions because of feelings of guilt and worthlessness. The instruments bring out her desire to escape her current problems though she denies having suicidal ideas. The instrument shows that Amanda presents at least five of the significant symptoms required for diagnosis of major depressive disorder, MDD. This instrument offers a comprehensive text that is useful to any clinician making a personality disorder assessment.

Depression at the workplace can affect behavior, interpersonal interactions, and the productivity of the employee. DSM-IV-TR, an instrument that assesses personality disorders in Amanda, fails to identify the severity of her disorder. The tool presents an ambiguous diagnostic threshold because of inadequate coverage, and therefore, the employee behavior and attitude towards work should change. The employee is no longer motivated to perform their duties. As a result, they are late to work and do not make up for time lost. Loss of self-esteem reduces their interactions with their colleagues. They are not capable of contributing to debates and are also sensitive to criticism.