Posted: March 21st, 2023

Ms. Z is a 28-year-old assistant store manager

Ms. Z is a 28-year-old assistant store manager who arrives at your outpatient clinic complaining of sadness after her boyfriend of 6 months ended their relationship 1 month ago. She describes a history of failed romantic relationships, and says, “I don’t do well with breakups.” Ms. Z reports that, although she has no prior psychiatric treatment, she was urged by her employer to seek therapy. Ms. Z has arrived late to work on several occasions because of oversleeping. She also has difficulty in getting out of bed stating, “It’s difficult to walk; it’s like my legs weigh a ton.” She feels fatigued during the day despite spending over 12 hours in bed and is concerned that she might be suffering from a serious medical condition. She denies any significant changes in appetite or weight since these symptoms began. Ms. Z reports that, although she has not missed workdays, she has difficulty concentrating and has become tearful in front of clients while worrying about not finding a significant other. She feels tremendous guilt over “not being good enough to get married,” and says that her close friends are concerned because she has been spending her weekends in bed and not answering their calls. Although during your evaluation Ms. Z appeared tearful, she brightened up when talking about her newborn nephew and her plans of visiting a college friend next summer. Ms. Z denied suicidal ideation.

Based on the information provided, it seems that Ms. Z is experiencing symptoms of depression. Her recent breakup, history of failed relationships, oversleeping, difficulty getting out of bed, fatigue, difficulty concentrating, tearfulness, and feelings of guilt and inadequacy are all characteristic symptoms of depression. Her employer’s suggestion to seek therapy is appropriate given her symptoms.

It is important to rule out any potential medical conditions that could be contributing to her symptoms, so a physical examination and laboratory tests may be warranted. However, given the constellation of symptoms, it is likely that Ms. Z’s symptoms are primarily related to depression.

It is also notable that Ms. Z experiences some moments of positive affect, such as when she talks about her nephew and her plans to visit a friend. This suggests that her depression may not be severe, and that she may benefit from therapy to help her manage her negative emotions and develop more positive coping strategies. It is encouraging that she denied any suicidal ideation, but it is important to continue monitoring her for any changes in mood or behavior.

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