In the case of Ellen Waters, she initially presents as someone that may suffer from Major Depressive Disorder, however, at the end of the case, it describes a person who appears to also suffer from hypomanic episodes, so it would be most fitting to diagnose Ellen with Bipolar Affective Disorder II. It appears that Ellen struggles with long periods of depressed episodes, where she withdraws, ruminates on failures, difficulty concentrating, somatic symptoms-arms and legs that feel like dead weight, lethargy, over sleeping and disrupted sleep patterns as well as, passive suicidal ideation, with no clear means or plan and her last attempts were in her adolescent years. It was documented that Ellen struggles with brief periods of feeling “high”
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when reactive to a negative life event. It appears that Ellen would benefit from psychopharmacology such as Depakote, lithium bicarbonate. However, it may also behoove us to consider using abilify to augment an SSRI-as long as the SSRI does not activate her hypomania (Beidel et al/ 2014). Ethically it would be best to boundary Ellen, to inform her that treating her with psychotherapy alone, is not in her best interest. Multiple studies that were reviewed and summarized conclude that conjunctive therapies have higher efficacy rates that traditional talk therapies alone (Beidel et al. 2014).
I would also suggest that it be best to consider either a partial hospitalization program; where they can administer and monitor a medication regimen during an intensive 6-hour therapy program or an intensive outpatient program, 2-3 hours of therapy for 3 days a week, while seeing a psychiatrist once a month. Both can address her psychiatric and counseling needs but at two different acuities, with cultural considerations being taken in account during those
when reactive to a negative life event. It appears that Ellen would benefit from psychopharmacology such as Depakote, lithium bicarbonate. However, it may also behoove us to consider using abilify to augment an SSRI-as long as the SSRI does not activate her hypomania (Beidel et al/ 2014). Ethically it would be best to boundary Ellen, to inform her that treating her with psychotherapy alone, is not in her best interest. Multiple studies that were reviewed and summarized conclude that conjunctive therapies have higher efficacy rates that traditional talk therapies alone (Beidel et al. 2014).
I would also suggest that it be best to consider either a partial hospitalization program; where they can administer and monitor a medication regimen during an intensive 6-hour therapy program or an intensive outpatient program, 2-3 hours of therapy for 3 days a week, while seeing a psychiatrist once a month. Both can address her psychiatric and counseling needs but at two different acuities, with cultural considerations being taken in account during those