Alan Eiland 5/5/2018

Jessica, a 28 year old married second year medical resident at a large hospital, is in

psychological distress. She is normally a high achiever, performing very well in both college and

medical school and is very self-critical if she falls short of the high standards she sets for herself.

Currently she is struggling with feelings of worthlessness and shame because she is unable to

perform as well as she has in the past. Based on the specifics of Jessica’s case, it can be

concluded that she is likely suffering from major depressive disorder, that she is responding to

this through the psychoanalytic process of denial, and that a possible path of treatment for Jessica

is Cognitive Behavioral Therapy.

The disorder that Jessica is presenting with is major depressive disorder. Symptoms for

major depressive disorder include depressed mood most or all of the time, dramatically reduced

interest/enjoyment of activities most or all of the time, lethargy or fatigue, feelings of

worthlessness or shame, difficulty concentrating, difficulty regulating sleep, listlessness, and

thinking repetitively of death or suicide. If someone has been experiencing at least 5 of these

symptoms over a two week period of time and one of the 5 symptoms is depressed mood or

reduced interest they likely have major depressive disorder. Jessica has for the past few weeks

experienced significant feelings of worthlessness and shame, fatigue, difficulty concentrating at

work, and insomnia. In addition her frequent tearful phone conversations, unusual irritable and

withdrawn demeanor, and tendency to call in sick and spend all day in bed indicate that she is

dealing with a depressed mood. These 5 symptoms are sufficient to demonstrate that Jessica is

suffering from major depressive disorder.

A psychoanalytic process that is likely impacting Jessica is denial. In the psychoanalytic

sense, denial is defined as refusing to acknowledge painful or unpleasant realities. When

Alan Eiland 5/5/2018

questioned by her husband about her tearful conversations with her friend, instead of opening up

about her feelings of worthlessness and shame about her inability to perform to the standards she

is used to in her job, Jessica instead denies this reality. She lies to him and tells him everything is

fine. This denial is likely because acknowledging the fact that she is not able to meet her own

standards is painful.

A possible treatment for Jessica’s major depressive disorder is Cognitive Behavioral

Therapy (CBT). CBT seeks not only to alter thought processes but also behaviors. The therapy

operates by typically seeking to change behaviors and then focus on cognitive change. CBT is

often used to treat depressive disorders, helping people to replace harmful thought patterns with

more appropriate appraisals of their situations and encouraging them to practice behaviors

“incompatible with their problem” (Myers 669). In Jessica’s case, CBT might be used to address

her thoughts of worthlessness and shame and help her replace her negative responses to stress

and low mood (staying in bed, being irritable, not being open with her husband) with more

positive behaviors.

Jessica’s major depressive disorder is having a significant impact on her life. She presents

with the requisite 5 symptoms to qualify for the disorder, which is causing strain in her

relationships with her coworkers and husband and impacting her work performance. Because she

finds it painful to acknowledge that she is struggling with feelings of worthlessness because she

can’t meet her own standards, she denies that anything is wrong when confronted by her

husband. The best way to address these issues is through CBT. Both Jessica’s harmful thought

patterns and her harmful behaviors can be addressed through this process.
Alan Eiland 5/5/2018

Cognition in Major Depressive Disorder (Oxford Psychiatry Library)

Roger S. McIntyre, Danielle S. Cha, and Joanna K. Soczynska
Oxford University Press, May 2014

Preventing the onset of major depressive disorder: A meta-analytic review of psychological interventions

Kim van Zoonen Claudia Buntrock David Daniel Ebert Filip SmitCharles F Reynolds, III Aartjan TF

Beekman Pim Cuijpers

Alan Eiland 5/5/2018

International Journal of Epidemiology, Volume 43, Issue 2, 1 April 2014, Pages 318–329,

https://doi.org/10.1093/ije/dyt175
Published: 22 April 2014
Abstract

Background Depressive disorders are highly prevalent, have a detrimental impact on the quality of life of patients

and their relatives and are associated with increased mortality rates, high levels of service use and substantial

economic costs. Current treatments are estimated to only reduce about one-third of the disease burden of depressive

disorders. Prevention may be an alternative strategy to further reduce the disease burden of depression.

Methods We conducted a meta-analysis of randomized controlled trials examining the effects of preventive

interventions in participants with no diagnosed depression at baseline on the incidence of diagnosed depressive

disorders at follow-up. We identified 32 studies that met our inclusion criteria.

Results We found that the relative risk of developing a depressive disorder was incidence rate ratio = 0.79 (95%

confidence interval: 0.69–0.91), indicating a 21% decrease in incidence in prevention groups in comparison with

control groups. Heterogeneity was low (I2 = 24%). The number needed to treat (NNT) to prevent one new case of

depressive disorder was 20. Sensitivity analyses revealed no differences between type of prevention (e.g. selective,

indicated or universal) nor between type of intervention (e.g. cognitive behavioural therapy, interpersonal

psychotherapy or other). However, data on NNT did show differences.

Conclusions Prevention of depression seems feasible and may, in addition to treatment, be an effective way to delay

or prevent the onset of depressive disorders. Preventing or delaying these disorders may contribute to the further

reduction of the disease burden and the economic costs associated with depressive disorders.