Case Scenario (only give the answers when specifically asked):

Your background:

Peter Smith, 52, unemployed, type 11 (two) diabetic with a history of depression since a young age.

You live with your partner Sally in a one-bedroom flat.

You support your partner who has asthma and has severe attacks about twice  year.

You have been isolating since the COVID 19 outbreak and neither of you have any symptoms which may be linked to COVID 19.

The presenting complaint (why you have come to see the clinician):

You think your depression is getting worse, as you cannot sleep well (about 4 -5 hours a night and you wake at 5am). You feel low, particularly in the mornings. Your sexual urges are lower than usual, and you don’t enjoy things like you used to e.g. listening to music. You are not feeling suicidal…’I have felt suicidal years ago, but I don’t now’. You feel this has been getting worse over the past two weeks. Nothing seems to improve your mood, although you do feel a bit better later in the day.

You are worried that you will not be able to look after your partner properly due to your low mood, and that you may ‘fall to pieces’ if she has an asthma attack, especially as COVID is still around.

You would like something to help with the depression and would consider counselling and / or antidepressants. In the past (about 5 years ago you took Citalopram and it helped). You took it for 6 or 7 years and came off it gradually with the help of advice from a friend.

Your past medical history (only if asked):

Diagnosed with type 2 diabetes 10 years ago. ‘It runs in the family’.

Suffered from  depression since late 20s, treated with citalopram by GP, and this helped. Never seen by any other Mental Health Clinician or Services.

Had appendix out as  a child, otherwise no hospital admissions.

Sees the Diabetic Nurse every 3-6 months.

Does not smoke.

Drinks ‘a bottle of beer a day, that’s all’

Does not used street drugs. ‘Dabbled’ as a teenager.

Not overweight & weight has been stable for 10 years.

Has a 29-year-old son  by a  previous relationship.

Exercises daily, reluctantly as feeling so low.

Mum and dad alive and live nearby.

Family history of diabetes, dad had it.

Mum has dementia, at an advanced stage.

No other serious illnesses in the family.

Your medication history:

• You take Metformin 500mg three times a day for type two diabetes. You have been taking this for about 5 years now. You see the Diabetic Nurse regularly and feel your diabetes is under control, and you saw the nurse last week who confirmed this.
• You have not had any other medicines prescribed in the last 3 months.
• You do not buy over the counter medicines. In fact, you dislike taking any medicines.
• You have not borrowed anyone’s medicines.
• All your vaccinations are up to date.
• You do not take supplements, or vitamins or take part of complementary therapies  or buy medicines over the internet.
• You have just bought some St John’s Wort (herbal remedy) to see if this helps your depression but have not started taking it yet.
• If a medicine if prescribed for you always take it or tell the doctor if you stop.
• You are not allergic to any medicines as far as you know, you are allergic to Elastoplast (it brings you out in a rash).

If asked about the response to citalopram – Oh yes ‘citalopram’ I was a bit addicted to that it was hard to come off, I kept feeling so shaky’.

Your social and family history:

• Non smoker
• Moderate drinker of alcohol
• Family history of diabetes
• Lost job 3 years ago, picks up some casual work as a decorator and on job seekers allowance. Previous occupation a painter and decorator
• No recent foreign travel
• No risky hobbies
• Been with current partner for many years
• Hasn’t taken any street drugs since teenage years
• Normal childhood
• No mental, illness in the family ‘that I know of’, ‘I did wonder if my dad was depressed some years ago’