Important Elements
The case presents some very important elements in the description of the patient’s condition. The first is an obvious feeling of sadness and anger, both of which are common for depressive disorders. The lack of sleep over a long period of time is another usual symptom that has to be considered. The most important information, however, comes from the description of her pregnancy and postpartum state. Although the patient did not experience depression during her pregnancy, the symptoms have become evident after the child was delivered.
The results of the MDQ screening suggest that this is likely to be a result of a bipolar disorder caused by hormonal issues (Jones, Chandra, Dazzan & Howard, 2014). Other significant symptoms such as avoiding social contact could also suggest a major depressive episode is responsible (Sharma et al., 2013).
DSM-IV Definition of Major Depression
It is not clear whether the current case fits the DSM-IV definition of major depression due to a lack of certain information. However, utilizing only the currently available symptoms, it still remains a possibility. Irregular sleep, sadness, and impairment in social areas of functioning are present and could signal the presence of major depression. However, not all of the requirements are met, and therefore it is impossible to state that this is the case (Uher, Payne, Pavlova & Perlis, 2013).
Additional Information
Additional information about a few aspects of the patient’s condition is required. The case does not describe any dietary habits of the patient and whether the present condition affected them. The patient should also be asked about having thoughts of death, experiencing fatigue, guilt, and psychomotor agitation. This information could serve to add evidence of major depression. Information about possible manic behavior could also prove vital to the final diagnosis (Pope, Sharma, & Mazmanian, 2014).
Diagnosis
The differential diagnosis for this patient is divided between a bipolar disorder caused by hormonal issues after pregnancy and major depression. The most likely diagnosis based on current information is bipolar disorder. If additional information does not contradict it, bipolar disorder will remain the most likely diagnosis. As a possible third option, postpartum depression should also be considered. However, the results of the MDQ screening show that bipolar disorder is more likely to be present in this case (Liu et al., 2017).
Care Plan
The care plan in case of a confirmed bipolar disorder should include therapy, stress management, exercise, as well as a number of pharmacological treatments to reduce the mood swings. The type of medication will depend on whether the patient experiences manic episodes or only depression. The majority of presented symptoms suggest that depression is the main factor and therefore the treatment will likely include appropriate doses of quetiapine and fluoxetine. Lithium and Divalproex could be considered for use as second-line options. However additional research into their use might be required (Yatham et al., 2012).
Difference of Major Depression and Bipolar Disease in Women
The difference between people of different genders experiencing these diseases is relatively small. However, a number of clinical characteristics can distinguish them. Women often experience more depressive episodes, both in the case of bipolar disease and major depressive disorder. Women also have shown to require more hospitalization when experiencing mania. The prevalence of these disorders and their variations are distributed almost equally between genders (Parial, 2015).
References
Jones, I., Chandra, P., Dazzan, P., & Howard, L. (2014). Bipolar disorder, affective psychosis, and schizophrenia in pregnancy and the post-partum period. The Lancet, 384(9956), 1789-1799.
Liu, X., Agerbo, E., Li, J., Meltzer-Brody, S., Bergink, V., & Munk-Olsen, T. (2017). Depression and anxiety in the postpartum period and risk of bipolar disorder. The Journal of Clinical Psychiatry, 78(5), 469-476.
Parial, S. (2015). Bipolar disorder in women. Indian Journal of Psychiatry, 57(6), 252.
Pope, C., Sharma, V., & Mazmanian, D. (2014). Bipolar disorder in the postpartum period: Management strategies and future directions. Women’s Health, 10(4), 359-371.
Sharma, V., Xie, B., Campbell, M., Penava, D., Hampson, E., Mazmanian, D., & Pope, C. (2013). A prospective study of diagnostic conversion of major depressive disorder to bipolar disorder in pregnancy and postpartum. Bipolar Disorders, 16(1), 16-21.
Uher, R., Payne, J., Pavlova, B., & Perlis, R. (2013). Major depressive disorder in DSM-5: Implications for clinical practice and research of changes from DSM-IV. Depression and Anxiety, 31(6), 459-471.
Yatham, L., Kennedy, S., Parikh, S., Schaffer, A., Beaulieu, S., Alda, M., … Berk, M. (2012). Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013. Bipolar Disorders, 15(1), 1-44.