Chelsea was a 43-year-old married librarian who came to an outpatient mental health clinic with a long history of depression. She described being depressed for a month since she began a new job. She had concerns that her new boss and colleagues thought her work was poor and slow, and that she was not friendly. She had no energy or enthusiasm at home. Instead of playing with her children or talking to her husband, she watched TV for hours, overate and slept long hours. She gained six pounds in just three weeks, which made her feel even worse about herself. She cried many times through the week, which she reported as a sign that “the depression was back.” She also thought often of death but had never attempted suicide.

Chelsea said her memory about her history of depression was a little fuzzy, so she brought in her husband, who had known her since college. They agreed that she had first become depressed in her teens and that she had had at least five different periods of depression as an adult. These episodes involved depressed mood, lack of energy, deep feelings of guilt, loss of interest in sex and some thoughts that life wasn’t worth living. Chelsea also sometimes had periods of “too much” energy, irritability and racing thoughts. These episodes of excess energy could last hours, days or a couple of weeks.

Chelsea’s husband also described times when Chelsea seemed excited, happy, and self-confident — “like a different person.” She would talk fast, seem full of energy and good cheer, do all the daily chores and start (and often finish) new projects. She would need little sleep and still be up the next day.

Because of her periods of low mood and thoughts of death, she had seen mental health care providers since her mid-teen years. Psychotherapy had given some help. Chelsea said that it “worked okay” — until she had another depressive episode. She could then not attend sessions and would just quit. She had tried three antidepressants. Each gave short-term relief from the depression, followed by a relapse. An aunt and grandfather had been in the hospital for mania, although Chelsea was quick to point out that she was “not at all like them.”

Chelsea was diagnosed with bipolar II disorder and as having a current depressive episode. Her husband’s information about her moments of hypomania helped in making the diagnosis.

 

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