What approach would you suggest for this patient? Which of her symptoms would concern you and require immediate intervention? Which medications would you use, include dosage and schedules.

GF is 41year-old woman who arrives for her first visit at the clinic. She reports that she has been feeling sad and depressed, with crying spells, trouble sleeping, increased appetite, impaired concentration, and fatigue. She has experienced depression in the past but was able to overcome the symptoms without medication. Upon physical exam, she appears to be poorly groomed and with minimal facial expression. She is slow to respond to questions. She admits to being very anxious and worried about “everything.” She denies any current suicidal ideation. However, she expresses concerns about the future and that it may not be an improvement. She has tried over-the-counter medications to help with sleep, but they have not been effective. Answer the following questions:

• What additional information would you gather before making a decision about what to do with GF?
• What approach would you suggest for this patient? Which of her symptoms would concern you and require immediate intervention? Which medications would you use, include dosage and schedules.
• Does she need to be referred to another provider, or can she be managed in a primary care setting?
• Are there any non-pharmacological strategies that might be appropriate for her depression and insomnia? Include highlights of patient teaching and /or lifestyle alterations. Support your decisions with at least one reference to a published clinical guideline and one peer-reviewed publication.

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