Major Depressive Disorder (MDD) is a common mental health disorder characterized by persistent low mood, decreased interest or pleasure in usual activities, fatigue, and marked changes in sleep and appetite. Emotional stressors, such as bereavement or traumatic events, are often identified as initial triggers. These stressors may lead to deteriorations across emotional, cognitive, and physical domains, affecting an individual’s quality of life and social functionality. According to Bains and Abdijadid (2023), MDD can significantly impair daily functioning and may evolve into a chronic condition without appropriate intervention.

Patient Assessment and Psychosocial Background

Ivy Jackson, a 63-year-old woman, presents with clear symptoms indicative of MDD. Her recent separation following her husband’s disclosure of a long-term affair marks a major psychological trauma. Ivy’s clinical assessment involved a full psychosocial evaluation, highlighting her vulnerability due to previous emotional stressors and familial predisposition to depression. Such evaluations are crucial in determining individual risk factors and tailoring evidence-based therapeutic strategies to address psychological dysregulation and foster recovery.

Her symptomatology includes pronounced emotional and physical exhaustion, along with disrupted sleep and eating patterns. Ivy’s marital breakdown after nearly four decades of partnership has severely affected her sense of self-worth and mental stability. Additionally, medication non-adherence due to side effects of venlafaxine has contributed to the exacerbation of symptoms. The assessment also revealed that Ivy has withdrawn from social activities and routine engagements, further isolating herself during a period of heightened vulnerability.

A comprehensive psychiatric evaluation confirmed that Ivy meets the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) criteria for MDD. Her presentation includes hallmark symptoms such as anhedonia, persistent low mood, and impaired concentration lasting longer than two weeks. Despite the absence of suicidal ideation, her emotional detachment and inability to cope effectively warrant immediate and structured therapeutic intervention. Biological underpinnings of MDD, including disturbances in neurochemical regulation and hypothalamic-pituitary-adrenal (HPA) axis dysregulation, may persist independent of stress resolution (Bains & Abdijadid, 2023).

Case Study

Clinical Analysis Using the 3Ps Framework

Ivy’s condition can be further understood through the lens of the 3Ps model—Presenting Problem, Predisposing, Precipitating, Perpetuating, and Protective Factors. This framework enables a structured exploration of the multiple dimensions influencing her mental health, offering clarity for a personalized treatment plan. The table below outlines the summary of Ivy Jackson’s case:

Table 1: Summary of Ivy Jackson’s Case Based on the 3Ps Framework

Category	Details
Presenting Problem	Chronic fatigue, disturbed sleep, low mood, anhedonia, and anxiety post-divorce.
Predisposing Factors	Family history of depression, long-term relationship, history of psychological stressors.
Precipitating Factors	Husband’s affair and divorce, withdrawal from venlafaxine due to adverse effects.
Perpetuating Factors	Social withdrawal, lack of structure, absence of therapy, continued emotional distress.
Protective Factors	Motivation for recovery, absence of suicidal ideation, willingness to engage in treatment.
Diagnosis	Major Depressive Disorder, aligned with DSM-5-TR diagnostic guidelines.
Treatment Plan	SSRI (escitalopram), cognitive-behavioral therapy, regular exercise, and structured routines.

Differential Considerations and Treatment Strategy

Ivy’s symptoms are more severe and prolonged than what is typically seen in situational depression or uncomplicated grief. Therefore, alternative diagnoses such as adjustment disorder are ruled out. The biological and psychological dimensions of MDD necessitate a multifaceted approach. Restarting pharmacological treatment with a selective serotonin reuptake inhibitor (SSRI), specifically escitalopram, is recommended. In addition, incorporating cognitive-behavioral therapy (CBT) will support her cognitive restructuring and help her rebuild emotional resilience. Lifestyle modifications such as improved sleep hygiene, scheduled activities, and community re-engagement are also integral to holistic recovery and relapse prevention.

References

Bains, N., & Abdijadid, S. (2023). Major depressive disorder. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559078/