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 usually works 3 – 12 hours shifts a week. 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 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?