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D. R. is a 24-year-old who has tried three times to complete his college education. While he initially is engaged and excited about classes, he struggles with keeping up with homework. He has had test anxiety in the past and once failed a midterm because he did not show up and did not email the instructor to make up the test. Currently, D. R. cannot continue in school because past failures of classes have stopped government assistance with school.

D.R. has felt he never measured up to his other family members who all seem to do just fine in life.

D.R. has been on antidepressants since graduating from high school when he was diagnosed with major depression.

D. R. lives with 4 other young men who are supportive but are busy with their own lives and really don’t understand why D.R. doesn’t just get out of bed even though he is tired. D. R. used to like hiking, playing guitar, biking, and hanging out with friends. Now he states is tired, tired of being depressed all the time and feels stuck emotionally.

Medically, D. R. has tried various antidepressants with varying success. Sometimes he has run out of his medication or the insurance company has messed up and not sent them in time. If he has the medication, D. R. takes them as directed. Alcohol use is occasional, and he also sometimes smokes or uses a hookah

Write down your assessment of D. R. and signs of depression he is exhibiting:

Write 8 questions you would ask D. R. (not necessarily all at once) to conduct further assessment (things you would like to know about him, how he feels, what his goals are, etc.):

Of the following treatments the doctor is offering, list pros and cons of each treatment and indicate which one you would recommend for D. R. at this stage:

  1. Continue adding/changing antidepressants
  2. Add Lithium to medication regime
  3. TMS
  4. ECT
  5. Holistic options

List 10 small steps you would recommend for D. R. (again, not necessarily attempted all at the same time):

List areas of cognitive behavior therapy you would address if you were seeing D. R. on a regular basis:

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