Ms. S.W. is a 48-year-old white female who presented to an outpatient community mental health agency for evaluation of depressive symptoms. Over the past eight weeks she has experienced sad mood every day

Ms. S.W. is a 48-year-old white female who presented to an outpatient community mental health agency for evaluation of depressive symptoms. Over the past eight weeks she has experienced sad mood every day, which she describes as a feeling of hopelessness and emptiness. She also noticed other changes about herself, including decreased appetite, insomnia, fatigue, and poor ability to concentrate. The things that used to bring Ms. S.W. joy, such as gardening and listening to podcasts, are no longer bringing her the same happiness they used to. She became especially concerned as within the past two weeks she also started experiencing feelings of worthlessness, the perception that she is a burden to others, and fleeting thoughts of death/suicide.Ms. S.W. acknowledges that she has numerous stressors in her life. She reports that her daughter’s grades have been steadily declining over the past two semesters and she is unsure if her daughter will be attending college anymore. Her relationship with her son is somewhat strained as she and his father are not on good terms and her son feels Ms. S.W. is at fault for this. She feels her career has been unfulfilling and though she’d like to go back to school, this isn’t possible given the family’s tight finances/the patient raising a family on a single income.Ms. S.W. has experienced symptoms of depression previously, but she does not think the symptoms have ever been as severe as they are currently. She has taken antidepressants in the past and was generally adherent to them, but she believes that therapy was more helpful than the medications. She denies ever having history of manic or hypomanic episodes. She has been unable to connect to a mental health agency in several years due to lack of time and feeling that she could manage the symptoms on her own. She now feels that this is her last option and is looking for ongoing outpatient mental health treatment.Past Medical History·              Hypertension, diagnosed at age 41Past Surgical History·              Wisdom teeth extraction, age 22Pertinent Family History·              Mother with history of Major Depressive Disorder, treated with antidepressants·              Maternal grandmother with history of Major Depressive Disorder, Generalized Anxiety Disorder·              Brother with history of suicide attempt and subsequent inpatient psychiatric hospitalization,·              Brother with history of Alcohol Use Disorder·              Father died from lung cancer (2012)Pertinent Social History·              Works full-time as an enrollment specialist for Columbus City Schools since 2006·              Has two children, a daughter age 17 and a son age 14·              Divorced in 2015, currently single·              History of some emotional abuse and neglect from mother during childhood, otherwise denies history of trauma, including physical and sexual abuse·              Smoking 1/2 PPD of cigarettes·              Occasional alcohol use (approximately 1-2 glasses of wine 1-2 times weekly; patient had not had any alcohol consumption for the past year until two weeks ago)