A 38-year-old woman presents to the office with complaints of weight
loss, fatigue, and insomnia of 3-month duration. She reports that she has
been feeling gradually more tired and staying up late at night because
she can’t sleep. She does not feel that she is doing as well in her occupation
as a secretary and states that she has trouble remembering things.
She does not go outdoors as much as she used to and cannot recall the
last time she went out with friends or enjoyed a social gathering. She
feels tired most of the week and states she feels that she wants to go to
sleep and frequently does not want to get out of bed. She denies any
recent medication, illicit drug, or alcohol use. She feels intense guilt
regarding past failed relationships because she perceives them as faults.
She states she has never thought of suicide, but has begun to feel increasingly
Her vital signs and general physical examination are normal, although
she becomes tearful while talking. Her mental status examination is significant
for depressed mood, psychomotor retardation, and difficulty attending
to questions. Laboratory studies reveal a normal metabolic panel, normal
complete blood count, and normal thyroid functions.
➤ What is the most likely diagnosis?
➤ What is your next step?
➤ What are important considerations and potential complications of