Ellen Waters is a 37 year old graduate student that is referred for a medication consultation because of depressed mood and panic attacks. Ellen looks unhappy and reports that she has felt unhappy for most of her life. She is in a long term relationship with a boyfriend that she reports does not want to marry or cohabitate with her. Her current boyfriend, and boyfriends in the past, have had difficulties with her "neediness." Her family history includes a father that was an alcoholic and parents that emotionally abused her. Ellen was referred for treatment at 14 years old after a suicide attempt, but has not sought treatment despite continuing low-level depression. Ellen reports that she is also very reactive to events. For example, attention from others can make her feel good for hours. Conversely, rejection from others can spark avoidance or social withdrawal. Academically and vocationally, Ellen is inconsistent. She frequently changes jobs and has spent a large chunk of her adulthood as a student. When asked about "high" periods, Ellen does report that she has experienced periods of elevated mood which can last for months. During these times, she runs on little sleep, has racing thoughts and creates huge phone bills. Ellen reports that although her friends may urge her to slow down during these times, she feels she gets a lot done and …show more content…
They state that it is viewed as a primarily genetic disease and that environmental stressors can trigger the onset. This makes sense considering that Ellen reported several stressors as a child and adolescent. She stated that her father was an alcoholic, her parents' marriage was unstable and that they were emotionally abusive. It would be helpful to know if there was a background of mental illness in her family. The substance abuse problem, marital discord and emotional abuse could indicate that one or both parents suffered from some form of mental