Sleepy and depressed. Please help.

Thank you for taking my case.

Patient ID: Sex: Age: Nature of work: Habits:
Female, 35, English Teacher, Single
Habits: worrying, sedentary, secluded life-style, resting/sleeping a lot

Please answer the following questions in a descriptive manner after careful analysis and recollection of previous experiences and happenings.

1. Describe your main suffering?
Depression, anxiety (also social anxiety), lethargy

2. What other physical sufferings do you have in your body?
Insomnia, disturbed sleep, sleepy almost all day (have to take 3 strong expressos sometimes) occasional constipation, acne (always), easy perspiration, (foul odour of feet and arm pits), crusts in ears due to scratching to relieve itching (they are sensitive, have to cover ear under sheet when sleeping, ear holes for earrings get infected and swollen so cannot wear earrings), sensitive to pain, itchy nose, sensitive skin, some varicose veins caused by past bruising, some veins show through skin (eye area, chest,arms and legs),sometimes difficulty breathing (need plenty of air around me and have to take deep breaths when anxious), stomach aches (sad emotions, hunger, if can’t go to bathroom), occasional headaches (exercise in heat, direct sunshine, tired, hunger), tongue has off-white coating, some cracks, boils (towards back of mouth) irregular edge and red tip. Often eyes have tears when I yawn or in cold wind. Nails (thumbs are corrugated) have some white spots and there are cracks in my skin on my finger tips

3. What mental sufferings / feelings do you have associated with your physical sufferings?
Anxiety, depression, thinking too much, feeling inadequate, indecisive, changing my mind easily, feel hopeless, moody, insecure, too sensitive, not much hope for future, apathetic, rarely ever been enthusiastic. Lack of self-esteem, feel lonely, unloved, negative self-image and thoughts about self, need to be approved of. And I talk too little. I feel I don’t belong anywhere. I worry about what others think of me so I am inhibited to speak. Dislike solitude but in company feel uncomfortable (feel more at ease when teaching my students).

4. What exactly do you feel when you are at your worst? Describe the sensation in your own words.
I feel like I don’t know what I want from life, I’m dissatisfied with it and myself, I feel lonely (I have little social contact), sometimes I wish I could die or just disappear. When feel very low, I cry and want to be left alone resting in bed.

5. When did it all start? Can you connect it to any past event or disease?
Have always been quiet, reserved, shy, melancholic and self-critical since I was a child.
It worsened after a stressful job situation (in which I wasn’t appreciated by my co-workers). As a child I missed my Father (was jealous of him) because he worked away from home and is mostly emotionally detached to us children.

6. Which time of the day you are worst?
There’s no real pattern, perhaps the morning because I have to think about the day ahead.

7. What are the things which aggravate your suffering and which are those which ameliorate the same? Example- time, temperature, pressure, rubbing, washing, eating, tight clothing etc.
Aggravation: pre-menstrual, hot weather, stuffy rooms, cold humid weather, tight clothes which restrict my movements, constipation, worrying, direct strong sun light (always wear sunglasses), noise, un restful sleep, hunger.
Amelioration: sleep, eating, rubbing, cool weather, intestinal regularity, sometimes music, quiet.


8. Do your think your sufferings have relation to any external stimuli (like, change of place) or any internal biological changes in the body, like, menses (in females)?
Well, I do feel a little worse before menstruation.

9. When do you feel better, during hot weather or cold weather, humid or dry weather?
Dry cool weather.

10. Describe your general mental set up? Are you Moody, Arrogant, Mild, Agreeable, Changeable, Nervous, Suspicious, Easily offended, Quiet, Arguing, Irritating, Lazy etc.
Moody, Quiet, Apathetic, impatient and irritable sometimes, Mild, Changeable, Romantic (, mostly before menses), dislike routine, Anxious, Sad, sweet, Suspicious, Easily offended, Post-pone duties, High expectations (from myself and others), Critical (), Judgemental (), Distrustful (//), Give up easily, Stubborn regarding my opinions and way of thinking, Perfectionist, Fear of disapproval, Forgetful, Dislike mental work, A little forgetful. Want to be extrovert and spontaneous, have more courage in defending myself from being criticized unjustly. I let people walk all over me. Don’t feel at home anywhere. I think people don’t like me so I usually don’t tend to make the effort of being friendly in case I am rejected. I dislike being a burden on others if I am in a bad mood.

- How do you feel before or during a thunderstorm?
No different.

- Do you like being consoled during your tough times?
Yes, but it doesn’t help much. I get upset if I am totally ignored and people know I am not feeling well. A hug is enough to feel a little bit better. Crying doesn’t help; I only feel sadder and have a heavy heart.

- Are you sensitive to external stimuli like smell, noise, light etc?
Noise, stuffy air (dislike sauna), music (sensitive to some tunes) foul smells and sunlight.

- Do you have any typical habit or gesture like nail biting, causeless Weeping, talking to one self etc?
Picking at skin, bite nails, I used to smoke (but don’t anymore thanks to hom. meds), talking to myself (because I communicate little), causeless weeping watching romantic scenes in movies (usually before menses, in sleep seldomly.

- How do you feel about your friends, family, your children and especially your husband / wife?
I feel mostly indifferent towards family, which worries me. I’d like to be more loving and affectionate and feel like enjoying myself and going out with people I know.

11. What are your fears and do you dream of any situation repeatedly?
Don’t have specific fears but avoid very narrow tunnels and driving for fear of being involved in an accident
When overly anxious have night-mares: self- injuries, being ignored by others or repetitive scenes, or looking for something I don’t know of.

12. What do you crave for in food items and what are your aversions?
I crave for coffee (2 espressos, very strong) in the mornings; I love the taste, smell and the boost it usually gives me. Also it helps my intestinal regularity. Frequently I crave preserved meat, I enjoy cheese, wine (alcohol relaxes me but drink occasionally and not excessively. I live in Italy so I have learnt to appreciate coffee and wine), vegetables, pasta, bread and potatoes. I crave chocolate before menses sometimes.
Have few aversions: candied fruit and cappers.

13. How is your thirst: Less, Normal or Excessive?
Less (except during heat)

14. How is your hunger: Less, Normal or Excessive?
Slightly eccessive.

15. Is there any kind of food which your body can’t stand?
No, perhaps chick peas can give flatulence

16. Is your sweat normal or less or more? Where does it sweat more: Head, Trunk or Limbs?
More. When anxious. Under arms, feet and face (during exercise).

17. How is your bowel movement and stool type?
Not regular (sometimes more than once, sometimes none for 2/3 days in a row). Changeable but normal lately (since high diluting hom. rem I am taking), some mucous (after constipation)

18. How well do you sleep? Do you have a particular posture of sleeping?
Not well. Have to take anti-anxiety med to fall asleep and to avoid anxious dreams. Sleep on left side, pre-natal position.

19. Do you think you are able to satisfy your sexual desires in general?
Normal.

20. Do you have any strange, peculiar or unusual symptom or feelings? How are you different from others?
I feel detached from reality most of the time. I feel like most people have a normal life, which I’d love to have. I feel like I’m immature and don’t feel like an adult.

21. What medications have been taken earlier by you to treat the diseases and do you have any particular symptom surfacing after the medication?
I took antidepressants for 3 yrs but they provoked further memory problems, IBS, constipation, perspiration and other usual side effects.

22. What major diseases are running in your family?
Heart disease, diabetes, depression related to anxiety, OCD and schizophrenia.

23. Describe, how do you look like? Describe your overall appearance.
I am blonde, green eyes, light coloured skin, freckles (a few, more from sun-tanning). I get sunburnt easily or have itchy eruptions (chest and upper arms) due to strong sun or veins upper legs show through even more (become red). Have discoloration of skin (purple inner corner eyes, more right eye), tired looking eyes. Light brown irregular patch starting from shoulder down to elbow. Some white hair in one spot of head, cannot bear 100% wool on skin and sometimes clothes labels irritate it. I am fairly tall, (1,69 cm) slim but stomach is out of proportion (flabby). Have fleshy upper arms and calves. I used to put on weight easily (have stretch marks) but since using hom. meds, my weight is more stable.
(For Females)
24. If your menstrual cycles are not normal, please describe the irregularities, like pains, moods, flow type, clots etc.
Menses last 4 days, stops 3rd day, almost nothing on last day and is light flow. Used to have them every 25 days; since diagnosed depression started (7 yrs ago) they are every 23 (or 24). Blood is normal colour. Have lower lumbar pain before menses. Have extra acne before menses.

25. What major diseases have you had in your life and when. Please write them in a chronological manner.
Have not had major diseases.
At time of birth, my Mum told me I was ready to be delivered but the nurses said she had to wait some minutes for the doctor to arrive.
Had ears pulled back at age of 4 because sticking out a bit (hereditary)
Had bad worm infection at around that age.
I was almost run-over at age of 5 but have removed it from memory
I am very short-sighted (- 8.45 left and – 9.00 right). Started having problems around age of 10.
I used to have very week ankles and I would sprain them continuously at around the age of 10.
Had cyst removed from gum at around the age of 10.
Had irritable colon (IBS) 4 yrs ago.
Dislocated lumbar disk and lumbar hernia caused by lifting heavy objects 4 yrs ago.

Thank you for your kind attention. I hope I have given enough information for you to make a diagnose.

Kind regards