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