ABSTRACT
This chapter presents a case of a 38-year-old receptionist who is referred by her general practitioner (GP) to the psychiatric outpatient clinic as she has failed to respond to two different antidepressants. She went on to develop anhedonia, restlessness, poor sleep and excessive appetite leading to a weight gain of 6 kg over 6 months. Her eye contact is steady but she appears downcast and lethargic. After nearly 4 months of treatment she had continued low mood, low energy and anhedonia. Citalopram was discontinued and replaced with the tetracyclic antidepressant mirtazapine. There was an initial marginal improvement in her tiredness and sleep, but this was transient. Her speech is slow and soft though she gets somewhat agitated when talking about her father. Her mood is low and her affect reflects this. She describes ideas of hopelessness, helplessness and worthlessness. She does not have any ideas of self-harm. There is no evidence of any psychotic symptoms.
