Margaret Lockhart is a 42 year-old, never married woman who lost her job as a secretary in a real estate office a year ago and has not been able to find another job. She has no brothers or sisters and lives with her mother, who is a widow. She has made an appointment at the clinic at the urging of her mother. She is clean and neatly dressed. She appears older than her stated age and has a sad expression. She speaks slowly in a low, monotone voice.
She says that for the last six months she has been feeling tired all the time and says that she goes to sleep early but then wakes up at 2 a.m. and can’t get back to sleep until 4 or 5 a.m. She feels exhausted during the day. She has trouble concentrating and has given up looking for employment. She says that she feels worthless without a job and has stopped going out with her friends. Her mother is worried because Margaret has lost her appetite and is losing weight and because she stays in the house all day watching game shows. Margaret says that she sometimes feels that life is not worth living and has had fleeting ideas of suicide. She denies having a plan or intent. She says that she has not had any episodes of mania or hypomania. When asked about her childhood, she says that it was normal, without any illnesses or accidents, and then adds that her father committed suicide when she was 12 years old. She did well in school and attended a local college. Until recently, she was active in her church choir and in Habitat for Humanity but she has stopped participating in these activities.
• What differential diagnoses would you consider?
• How would you prioritize her problems?
• What interventions would you consider?