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Case study 1: Depression (Dyan)
Case study 1
General Area Dimension
Introduction Dylan is a 17-year-old man, who lives with his mother, father and brother who is 3 years older than him. His mother says he now sticks to himself. He has been referred to the treatment of depression. He feels hopeless and wants to sleep at the time.

Presenting the problem Dylan was referred to community mental health service by the counsellor of his school. But later it was disclosed as Dylan didn’t find any positive changes in his life by the mental health services. Dylan reports that his brother is annoying to him and doesn’t understand what his brother is going through now. Dylan considers himself a very ugly person.
Locating the person in a social context – social networks and family. Dylan plays in the band with his friends. The band is in collaboration with his friends. His girlfriend is the lead vocalist of the same band. He likes playing in the band. From the case notes, Dylan’s father is helpful and kind to him. He also makes him feel energized. Also, his mother stated that he doesn’t contribute to household works anyway.
Relevant personal, family, medical, employment and education histories. Personal: The case notes state Dylan has maintained a relationship with his girlfriend. His mother says he has no or very less interest in the household work. She also finds him taking things for granted. According to case reports he constantly argues with his brother. Even the arguments with his brother have turned into physical altercations.

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Education: Dylan is a school student. He has HSC exam in coming months, but he doesn’t find any motivation to prepare and study for his exams.
Medical: There is no any sign of past medical history of depression in Dylan. It has recently been developed in him.
Identifying the person’s understanding of their situation.

Dylan is currently experiencing the depression. He is more upset because of his looks. He is not motivated at all to study or prepare for his exams. Though it is just the initial stage of the depression he is not taking any anti-depression medications. Dylan appears t slow little to no sign of employing coping strategies for his depressive symptoms as such he seems to have a low self-esteem and low self-confidence. He uses his most of the time only in his band and spends most of his time with his friends. His mother is worry about the condition of his son as he is not giving interest at all in helping his mother. His mother is worried about the relationship with his brother as they keep fighting.

The current level of functioning
  Dylan seems to be overwhelmed by his current responsibilities and anxious about future responsibilities. Dylan isolates himself and keeps arguing with his brother. He has lost self-confidence and motivation on him Other than that Dylan does not appear to show any signs of undergoing stress management. Dylan apparent lack of motivation is the contributing factor of his depression.

Richard seems to struggle to cope with the everyday responsibilities as well as his studies.
Impact of the illness on functioning.

According to Dylan’s case, his depression has the negative impact on his personal and family relationship causing him to manage exceptional marks in exams. As his depression is not in depth the risk of suicidality is very less.

Identifying strengths and stressors
Strengths: Stressors:
Dylan’s good relationship with his father.

Inactive in the home.

Dedicated to his band.

Dislike his brother.

Enjoys being with his friends.

Not good.

Has the healthy relationship with his girlfriend.

Constant argues with brother.

Little effort in study.

Lack of motivation.

Feels ugly.

Reaching a conclusion about what the problem is. As seen in Charles Nemeroff, Christine Heim, Michael, Keller (2003), Dylan’s current situation is typical of someone suffering from depression. He experiences family conflict, stress, interpersonal problems. He doesn’t have any stress management strategies in a place. He is worried about his future as he was finding difficulty to concentrate. His depression is affecting all the aspects of his life including personal as well as academic.

Plans for the future Aim to:
Increase resilience through developing skills and resources using psychological and cognitive interventions (CBT or ACT, IPT & MBT).
Decrease avoidance by applying a problem-solving method so Dylan can develop his own solutions and encourage self-motivation in his life.
regular physical exercise to help lift mood and feelings through the release of “feel good” chemicals in the brain.

Provide stress management and coping strategies utilising mindfulness-based therapy (MBT).

Psychotherapy for the depressed patient.

Intake of anti-depressants tablets including Noradrenaline reuptake inhibitors and Tetracyclic antidepressants.

Reduce the risk of relapse by conducting family psychoeducation with his father and brother (Bland, et al., 2012).
One of the most commonly diagnosed mental health disorder is depression (Bland, et al., 2012, p. 109). Depression is a very broad term to discuss. Depression is more than just a low mood. It’s a serious condition that affects your physical and mental health. Treatments for depression are operative. If you reckon sings that someone depressed, professional help may be warranted. There are several kinds of medication; serotonin and norepinephrine reuptake inhibitors (SSRIs ; SRNIs), monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants, which could all have varying effects (Bland, et al., 2012). A different kind of medication may exacerbate or elevate his depressive symptoms. Other treatment options include electroconvulsive therapy (ECT). (Bland, et al., 2012). In the social worker’s opinion, it appears that Dylan is currently living in a tense and antagonistic relationship, on the verge of relationship breakdown, which is negatively affecting his depressive symptoms. Changes in his behaviour like unable to concentrate, withdrawing from close family and friends, feeling like guilty, frustrated, lack of confidence, disappointed, thoughts like I’m worthless, people would be better off without me all this thing was in his mind which was taking him to depression.

Talking about the therapies for the treatment of Dylan’s depression, psychotherapy often uses specific type of therapy to treat depression. Some of them usage an eclectic method, based on a client’s treatment needs. There are several types of therapy, a study surveyed which therapies are most effective for depression. Some of the following therapies were similarly operative in reducing depression. There has been quite a lot of research on the effects of cognitive-behavioural group therapy as a treatment for depression. According to the extensive mapping by, treating depression with cognitive-behavioural therapy is efficient and useful. have had comparable results. In their therapy, they tried to teach the patients skills that diminish depression. For example, they tried to develop the persons’ problem-solving skills. Treating depression with cognitive-behavioural therapy has proven efficient and useful. Cognitive behavioural therapy has led to the reduction in the levels of depression, negative involuntary thoughts, and students’ dysfunctional attitudes (Goodyer, Wright ; Altham, 2010). It has been proven that the symptoms of depression lessen during therapy.

Another anti-depressant therapy is Norepinephrine, also known as  noradrenaline, the element that is released mainly from the ends of sympathetic nerve fibres and that turns to increase the force of skeletal muscle contraction and the proportion and force of contraction of the heart. The actions of norepinephrine are vital to the fight-or-flight response, whereby the body formulates to react to or retreat from an acute threat. As part of the body’s response to strain, norepinephrine disturbs the way the brain pays attention and re-joins to procedures (Lopez?Duran, Nusslock, George, & Kovacs, 2012). It can also do the following, increment of heart rate, trigger the issue of glucose (sugar) into the blood, growth blood flow to muscles. As a neurotransmitter in the central nervous system, norepinephrine increases alertness and arousal and speeds reaction time. Norepinephrine has been shown to play a role in a person’s disposition and capacity to concentrate. Another type of anti-depressant is SSRIs. Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants ( Spielmans, Pasek, ; Mcfall,2007). They can ease symptoms of moderate to severe depression, are relatively safe and typically cause fewer side effects than other types of antidepressants do. SSRIs comfort depression by increasing levels of serotonin in the brain. Serotonin is one of the chemical messengers (neurotransmitters) that communicate signals between brain cells. SSRIs block the reabsorption (reuptake) of serotonin in the brain, making more serotonin accessible ( Spielmans, et al.,2007 ).SSRIs are called selective because they seem to primarily affect serotonin, not other neurotransmitters. However there are some side effects of the SSRIs are: drowsiness, nausea, dry mouth, insomnia, diarrhea, nervousness, agitation or restlessness, dizziness, sexual problems, such as reduced sexual desire or difficulty reaching orgasm or inability to maintain an erection (erectile dysfunction), headache, blurred vision (Charles,2003).

Depression cases are different varying in people. For instance, one individual may struggle to get out of bed because of depression, someone else might be able to work every day without co-workers noticing that he’s depressed. (Mammen, & Faulkner,2013). Sometimes, symptoms that look like depression aren’t depression. Substance abuse problems like medical, medication side effect or other mental health circumstances may produce symptoms that look like depression. Persons with depressive symptoms often seek validation for their own needs and actions from other people. In this manner, they strive to prove their worth, their competence or their likeableness. Those suffering from depression often have limited social skills (Mammen, ; Faulkner,2013). There are several causes inked with depression. Depression can affect anyone at almost any age .and the reasons why some people grow depressed isn’t always known but researchers suspect there are many causes of depression and it isn’t always preventable. Its estimated that 10 to 15 percent of the general population will experience clinical depression in their lifetime. And the world health organization estimates 5 percent of men and 9 percent of women experience depression disorders in a given year (Ronen ; Freeman, 2007). Research also says that long-term unemployment, living in abusive or uncaring relationship, long-term isolation, work stress are also causes of depression. Also, some of the reason can be losing the job which is also the reason for the depression. Depression is treatable, and most people see improvements in their symptoms when treated with medication, psychotherapy or a combination of the two. While the process of treatment it should be individual so that best treatment can be achieved because if group treatment is done may all the people have not the same problem, so treatment may not be successful.
Social workers play a key role in the depression treatment team. Social workers are the second largest allied health professionals providing mental health services including depression. Social workers do a variety of “talk therapies” which include individual counselling, calamity intervention services, family therapy, as well as the deployment of support networks. In case of Dylan, social workers can also accomplish case management occupations of monitoring medication agreement and assistance with maintaining medical schedules, especially important for people for whom depression is a deteriorating illness (Williamson, Birmaher, Dahl ; Ryan, 2005 ). Social work researchers often work in teams with researchers of other disciplines. Their research emphases on such subjects as the efficacy of medications in clinical tribunals, work with refugees who struggle to discover new connotations in new cultural contexts, issues of co-morbidity, e.g. depression co-occurring with substance abuse or eating disorders, or of inter-generational manifestations, including the challenging of intervention models with children or with the elderly in assisted living backgrounds.

To conclude, depression is a mental disorder that marks the mind and can have perceptible effects on physical and social wellness. Depression can affect anyone at any age. If a person with depression does not seek medical help, then the mental disorder might become worse. Dylan can get rid out of depression by the different strategies used by the social worker to make changes.

References
Bland, R., Renouf, N., ; Tullgren, A. (2015), Social Work Practice in Mental Health: An introduction. Crows Nest, New South Wales: Allen ; Unwin. Retrieved from Carers Queensland Australia. (2012). Services. Retrieved from http://carersqld.asn.au/services
Charles B. Nemeroff, J., Christine M. Heim, Michael E. Thase, Daniel N. Klein, A. John Rush, Alan F. Schatzberg, . . . Martin B. Keller. (2003). Differential responses to psychotherapy versus pharmacotherapy in patients with chronic forms of major depression and childhood trauma. Proceedings of the National Academy of Sciences of the United States of America, 100(24), 14293.Retrieved from http://www.pnas.org/content/100/24/14293.short
Dimatteo, M., Lepper, H., ; Croghan, T. (2000). Depression is a risk factor for noncompliance with medical treatment: Meta-analysis of the effects of anxiety and depression on patient adherence. Archives of Internal Medicine, 160(14), 2101-7.

Retrieved from jamanetwork.com/journals/jamainternalmedicine/fullarticle
Goodyear, I., Wright, C., ; Altham, P. (2010). The friendships and recent life events of anxious and depressed school-age children. The British Journal of Psychiatry: The Journal of Mental Science, 156, 689-98.Retrieved from https://www.cambridge.org/core/journals/psychological-medicine/article/recent-friendships-in-anxious-and-depressed-school-age-children
Lopez?Duran, N., Nusslock, R., George, C., ; Kovacs, M. (2012). Frontal EEG asymmetry moderates the effects of stressful life events on internalizing symptoms in children at familial risk for depression. Psychophysiology, 49(4), 510-521.Retrieved from https://www.annualreviews.org/doi/abs/10.1146/annurev.psych.48.1.191
Mammen, ; Faulkner. (2013). Physical Activity and the Prevention of Depression: A Systematic Review of Prospective Studies: A Systematic Review of Prospective Studies. American Journal of Preventive Medicine, 45(5), 649-657.
Retrieved from https://www.ajpmonline.org/article/S0749-3797(13)00451-0/fulltext
Prevention in young people | Black Dog Institute. (2018). Retrieved from https://www.blackdoginstitute.org.au/research/key-research-areas/prevention-in-young-people
Spielmans, Pasek, ; Mcfall. (2007). What are the active ingredients in cognitive and behavioural psychotherapy for anxious and depressed children? A meta-analytic review. Clinical Psychology Review, 27(5), 642-654.Retrieved from https://www.sciencedirect.com/science/article/pii/S0272735807000414
Ronen, T., ; Freeman, A. (2007). Cognitive behaviour therapy in clinical social work practice. New York: Springer Pub.

Takahiro Takano, Guo-Feng Tian, Weiguo Peng, Nanhong Lou, Ditte Lovatt, Anker J Hansen, . . . Maiken Nedergaard. (2007). Cortical spreading depression causes and coincides with tissue hypoxia. Nature Neuroscience, 10(6), 754-762.Retrieved from https://www.nature.com/articles/nn
Williamson, D., Birmaher, B., Dahl, R., ; Ryan, N. (2005). Stressful Life Events in Anxious and Depressed Children. Journal of Child and Adolescent Psychopharmacology, 15(4), 571-80. Retrieved from https://www.liebertpub.com/doi/abs/10.1089/cap.2005.15.571

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