Question: The Patient Is A 26-Year-Old College Graduate Who Is Currently Euthymic But Who Has A History Of Major Depressive Episodes

Patient Intake and History 

The patient is a 26-year-old college graduate who is currently euthymic but who has a history of major depressive episodes  He has experienced major depressive episodes, mostly untreated, of varying lengths and severities since he was a teenager His symptoms have included insomnia, despondent thoughts, depressed mood, low interest in activities, poor energy, and impaired cognition   He says his self-esteem drops and he feels rejection-sensitive and guilt-ridden for no apparent reason   He has never had suicidal thoughts   Some of the depressive episodes have been incapacitating and have interfered with school and work  

He appears to have good inter-episode recovery and is able to return to class and work

The patient also has symptoms of social anxiety 

He is often nervous around new people and acquaintances  

He experiences anticipatory anxiety and will avoid certain social events  

These symptoms are present regardless of his affective state 

He has asked for a consultation because he has legal issues regarding drinking and driving that he thinks were likely fueled by his psychiatric symptoms  

At the time of the infraction (several months ago, just before graduating college), he had been started on a selective serotonin reuptake inhibitor (SSRI) for the depression and SAD symptoms  

Within days of starting he experienced elevated mood in a sustained fashion over several days  

He lost all anxiety, fear, and avoidance

He was unusually talkative; had racing thoughts; was distractible, hyperactive, and impulsive; and had decreased need for sleep  


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