Clinical vignette
Mr. D is a 73-year-old divorced man who was brought to the emergency room by his daughter for suicidal ideation and depression. He mentioned few months’ history of continuous excessive worry about his future, panic attacks and loss of interest in life. He self-isolated and avoided seeing family and friends. He had gradually stopped all of the physical exercise activities (swimming, jogging and yoga) that he used to do, because he did not have the physical energy and mental joy. He had difficulty sleeping, decreased appetite and lost about 10 pounds in the past few months. Recently, he had been feeling very guilty about how he had treated his ex-wife who died of suicide by hanging 20 years ago, 10 years after their divorce. He thought he deserved to die and started to think about ending his life. He denied any delusions or hallucinations. He did not have any anxiety or other psychiatric symptoms prior to this episode except for few months of “psychotherapy” with a psychologist 30 years ago after his divorce.
His symptoms started few months ago when his company went bankrupt following a few months of struggling with tax audit and lots of financial problems. Then, he decided to retire. He used to be a very successful and high-achieving accountant who ran the company with his brother for more than 40 years. He suffers from diabetes mellitus type II, gout and a frozen shoulder. His medication list includes Vitamin B12, Metformin-Sitagliptin 1000mg+50mg, Valsartan-HCTZ 160mg+25mg, and Allopurinol. The only important family history was the chronic treatment-resistant depression in his mother.