A 40 year old schoolteacher presents with anorexia, mild to moderate insomnia, and fatigability for 3 weeks. She has also lost some weight, although the amount has not been quantified. Further questioning reveals diminished interest in almost all activities, and reduced pleasure when engaging in activities which she previously found pleasurable. She has a low mood, is unable to concentrate, and finds it difficult to carry out her day to day work. She also confesses that she had missed school for the past week. There is no history of suicidal thoughts, and she denies hearing voices, or believing that she is fatally ill, or that there is a conspiracy against her. She was completely healthy prior to this, with no history of elevated mood, overactivity, or expansive ideations. Nor has she ever required psychiatric consultations, or been hospitalized due to medical or psychiatric disease. There is no history of alcohol or drug abuse. She divorced 6 months ago, and is raising her three children by herself, with the youngest being 5 years of age.
The complete blood count is within normal parameters
TSH, Free T3, and Free T4 are all within normal ranges.
The PHQ-9 score is 13
The MRI scan of the brain is completely normal.