Depression, Part Five: Brenda

I am in my private office with a sixteen year old girl named Brenda. An otherwise attractive young lady, she is far too thin for her height and her hair is disheveled. She wears dirty jeans and a rumpled sweatshirt. There are dark circles under her eyes which she attributes to poor sleep that is punctuated by nightmares. Due mainly to poor attendance she is failing all of her school subjects despite good ability, and she plans to quit school at the end of the year. She has no plan for the future other than to "get a job." Her mother, a single parent with no other children, who is also depressed, works night cleaning offices. Brenda says she is not interested in that type of work.

Brenda's mother, a recovering alcoholic who "made a lot of mistakes when [she] was younger," does not know who Brenda's father might be. She raised Brenda with the help of her own mother, who died when Brenda was three. At the age of four, Brenda was sexually abused by one of her mother's many boyfriends. Brenda has no conscious recollection of this, although it was documented with photographs obtained by police after the fact. Brenda was verbally and emotionally abused by another one of her mother's boyfriends, and at the tender age of twelve tried to kill herself by swallowing half a bottle of aspirin. She was hospitalized briefly, then released back into her mother's care.

At the age of thirteen Brenda started drinking and prostituted herself after running away from home. She hitched a ride with a truck driver and was picked up by police in another state after several days on the street. Once home, and urged by school authorities to do so, Brenda's mother then filed papers to have her deemed a "Person in Need of Supervision." The court placed Brenda on probation and arranged for counseling for her, which she received for two years. During that time she was prescribed medications by three different psychiatrists. She says one of the medications helped her, but Brenda stopped taking it when her mother changed jobs and could no longer afford to buy it.

Brenda's primary diagnosis is Major Depressive Disorder. She feels "down in the dumps" nearly all of the time and often becomes angry at her mother over trivial matters. She eats junk food for breakfast when she has breakfast and on some days may not eat at all. She does not seem to care about herself, the future or what it might hold for her. A boy who was interested in her stopped seeing her after she stood him up for the fourth time, then became abusive of her by spreading rumors about her in school. Brenda again began entertaining suicide at that time. Thanks to a clinic with a sliding scale, she is back on medication which she often "forgets to take."

She often fails to keep her appointments with me, and her mother says she has given up on Brenda. Her prognosis is guarded to poor at this time.