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  1. Major Depression  





    Alejandro is a 34 y/o Hispanic male, civil engineer. He was brought in by his wife because he has suffered from depressive symptoms for the past month including disrupted sleep, loss of appetite, feelings of worthlessness, and wanting to die but not suicidal. He is admits to having suffered an episode of this in high school. He is diagnosed with DSM-5 Major Depressive Disorder, recurrent, moderate. He was started on Prozac 20mg once daily. He was also supposed to start psychotherapy. He stated at that time that he did had a hunting rifle in his home and that he should have it removed and not have any access to weapons.

    Alejandro returns to see you two weeks later. He says that he is still feeling sad, has decreased motivation, and feels that things are getting worse.

    What additional questions do you have now?
    Has your diagnosis changed? Please articulate your rationale.
    What medication(s) would you recommend and why?
    Identify one research or evidence-based practice article to support your responses and include the citation (with a link if available).

    Order Notes






Subject Nursing Pages 2 Style APA


Major Depression Case Study

This discussion focus on Alejandro, who is a 34-year old Hispanic male returning to the clinic for further diagnosis. The patient claims that he has reduced motivation, sadness, and feels that things are worsening.

Additional Questions

Alejandro has a history of Major Depressive Disorder, according to the DSM-5 diagnosis. However, it is imperative to further examine the increase in the severity of the symptoms and the possibility of new clinical manifestations. Additional questions in this regard include

  1. Is your preference staying at home or going out and engaging in new things? This question is aimed at recognizing withdrawal and isolation, which are common depression signs.
  2. How is your sleep pattern? Has it changed with medication? This is aimed at evaluating the risks of sleep disturbances.
  3. Do you feel hopeless?
  4. Do you still feel fatigued and lose energy?
  5. Do you have challenges with concentration and decision making?
  6. Have you experienced recurrent suicidal ideation or homicidal thoughts?
  7. Are you easily irritated?
  8. Was the hunting rifle removed? Do you have access to any other weapons?
  9. Who do you live with?
  10. Do you have any family supervision?


These questions are aimed at evaluating the severity of the depression, the risks, the patient’s social environment, and the effectiveness of Prozac 20 mg.


The diagnosis remains depression but changes to dysthymia, which is a combination of chronic major depressive disorder and dysthymic disorder. According to Parker and Malhi (2019), this state of depression lasts for more than two years. In Alejandro’s case, he feels like the symptoms have increased, including reduced motivation and heightened feelings of sadness. Besides, he had been diagnosed with the condition when he was in high school.


Alejandro should continue with the selective serotine reuptake inhibitors (SSRIs), Prozac (fluoxetine). However, the dosage should be increased to 40 mg per day since the symptoms have not improved upon the administration of 20 mg/day dose. Besides the drugs, the patient should undergo cognitive behavioral therapy (CBT) to assist in coping with the symptoms. According to Machmutow et al. (2017), psychotherapy is essential in promoting the patient’s recovery. A combination of the pharmacological and therapeutic intervention is vital in enhancing the individual’s quality of life and reducing a recurrence of the symptoms.





Machmutow, K., Jansen, A., Meister, R., Watzke, B., Härter, M. C., Kriston, L., & Liebherz, S. (2017). Continuation and maintenance treatments for persistent depressive disorder. The Cochrane Database of Systematic Reviews2017(11). Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6486155/

Parker, G., & Malhi, G. S. (2019). Persistent Depression: Should Such a DSM-5 Diagnostic Category Persist? The Canadian Journal of Psychiatry64(3), 177-179. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6405812/






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