SM is a 32 year old female that has come to see you for a diagnostic psychiatric evaluation due to a
long history of depression. She has begun to see the signs that she has seen in the past when her
depression is starting up again. She is sad for no apparent reason, cries easily, has little interest in
her hobbies, finds it difficult to get up and going, and sometimes isn’t even enjoying playing with her
son. This has never happened before. She wants to treat this before it gets any worse like it has in the
past. SM is not on any current medication and has not been for about 5 years. She is married and she
has stated that she and her husband are trying to add to the family.
After an extensive interview it was found that SM was a nurse working in a step down unit in the
local hospital. She works 3 – 12 hours shifts a week usually. She has a 33 year old husband of 9
years and 1 boy aged 2 1/2 years. SM stated that her husband is working part time while he is
finishing up his master’s degree. He will be done in August and they would like to have another child
once he is finished with school. She stated that she felt that she was tired of waiting to have another
child since she had some fertility problems with the first one and she is worried about how long it
will take her to get pregnant again. She reports that she breast fed her son and plans to breast feed
the next child. She had a physical by her PCP and she currently has no medical problems. She has a
history of PCOS (Poly Cystic Ovarian Syndrome) and she is overweight. SM stated she has
experienced some bouts with depression in the past and has been put on a medication but she doesn’t
remember what the name of it was. She maintains a fairly healthy diet and she walks and runs. She
has done several 5k’s and recently did a 10K. She has a very supportive family. Money is tight since
she is really the only income but she states that they are doing “ok”. She would like to move to a
larger home but she does see the light now at the end of the tunnel as he will be done with school in a
few months and be able to decrease the burden of the finances from her. She hopes this will enable
them to move in the near future to a larger home. She stated she had episodes in nursing school
where she could not sleep for “thinking” but that doesn’t seem to be a problem this time. She stated
she has 1-2 beers occasionally on the weekends, is a non-smoker, and did not take “street
drugs”. She is not taking any other medications except vitamins.
There are many ways to handle this issue so let’s discuss it. How would you treat?