Review Question - QID 214948

A 44-year-old woman with a history of diabetes and hypothyroidism presents to her primary care physician for depressed mood. These symptoms have persisted for the past 10 years. Her symptoms of increased appetite and sleeping all day have been much worse. She feels as if her arms and legs are “made of lead” and incredibly heavy, making it difficult to engage in everyday tasks. Her mood is very depressed and she is very sensitive to rejection. She feels guilty that she cannot accomplish more in her life as a result. She has minimal interest in her hobbies or spending time with friends anymore. Her medical history is significant for hypothyroidism, major depressive disorder, obesity, and chronic kidney disease. Before the current visit, she was prescribed fluoxetine and paroxetine each for a 2-year period with escalating doses but has noticed no improvement in her symptoms. The patient also has a medical history of obesity, chronic kidney disease, and a seizure disorder. She has had several breakthrough seizures this past month despite consistently taking her prescribed antiepileptics. Her temperature is 98.1°F (36.7°C), blood pressure is 142/82 mmHg, pulse is 86/min, respirations are 16/min, and oxygen saturation is 98% on room air. Physical exam reveals a young woman with a depressed mood. Her neurological exam is unremarkable. Laboratory studies are ordered as seen below.
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