Background

Violent bereavement, displacement, and loss of livelihood significantly affect mental health and hinder access to care. This report describes the management of depressive symptoms in a trader affected by banditry in northwestern Nigeria.

Case presentation

A 48-year-old married trader presented to Federal Medical Centre, Gusau, on 22 March 2022 with four weeks of low mood and three weeks of disturbed sleep following his son’s death after a kidnapping. His two daughters were released unharmed, but repeated attacks forced the family to relocate. He reported loss of interest in pleasurable activities, poor concentration, reduced appetite, fatigue, and impaired daily functioning. There was no history of suicidal though and ideation. Major depressive disorder was diagnosed, with adjustment disorder as a differential.

The diagnosis and management options were explained to him, and shared decision-making was achieved regarding his requested investigations. Due to financial constraints, he was commenced on tablet amitriptyline 25 mg nocte for two weeks. He was counselled on medication adherence, its side effects, and contraindications. He was further counselled on family support, lifestyle modification, and regular follow-up visits.

He was referred to a clinical psychologist for cognitive behavioural therapy (CBT) and was given a two-week appointment to see the author. He attended his monthly follow-up appointments with his wife regularly, with significant improvement. The dose of the tablet Amitriptyline was reduced to 12.5 mg on 22 June 2022 after symptom resolution and was discontinued on 22 December 2022, after psychoeducation on a relapse prevention plan. He was discharged from the clinic and referred to the wellness clinic.

Conclusion

This case demonstrates how patient financial circumstances, treatment preferences, and family-centred care influence clinical outcomes. It highlights the importance of diagnostic clarification, structured safety assessment, and relapse-prevention planning in trauma-related presentations in resource-limited primary care settings.

Keywords: Depressive symptoms; violent bereavement; banditry; patient-centred care; cognitive behavioural therapy; internal displacement; Nigeria.