Two Hospitalized Cases of Major Depressive Episodes With Comorbidities and Psychosocial Stressors: Case Reports

Abstract

Background: Major depressive episodes (MDEs) requiring hospitalization often arise from complex interactions among biological, comorbid, and psychosocial factors. This report presents two cases of MDEs with severe suicidality, comorbid conditions, and psychosocial stressors to highlight diagnostic and therapeutic challenges. Case Presentation: Case 1 involved a 58-year-old man with Hashimoto’s thyroiditis who developed worsening depressive symptoms, including suicidal ideation, following financial strain and family stressors. He required involuntary admission under the Mental Health and Welfare Act. Mirtazapine therapy combined with supportive psychotherapy led to remission within 2 weeks. Case 2 involved a 29-year-old woman with alcohol dependence who attempted suicide twice amid domestic violence and workplace harassment. She was admitted voluntarily and treated with escitalopram, trazodone, and supportive care, leading to clinical improvement. Discussion: Both cases demonstrated the multifactorial etiology of depression with suicidality, involving biological vulnerability, comorbid illness, and psychosocial adversity. Hospitalization ensured safety and provided a therapeutic environment for stabilization. Ongoing outpatient care, medication adherence, family education, and social support are essential for relapse prevention. Conclusions: Early inpatient intervention, comprehensive assessment of stressors and comorbidities, and multidisciplinary postdischarge care are crucial for managing recurrent depressive episodes with suicidality.