Case of the month:

Life events or trauma?

A 25-year-old female is diagnosed with anxiety, depression, and PTSD. As a child, she was raised in a supportive family with no known sexual or physical abuse. When she went to school, though, she experienced bullying and had conflicts with some female peers.  In college, she felt out of place and had a clinical depressive episode at age 18.  She met a young man whom she married and who has been very supportive. In the last few years, she has experienced continued anxiety anddepression, although no definable flashbacks and nightmares.  Her most recent period of worsening of symptoms relates to the passing of an aunt, to whom she was very close. Also, her husband recently lost his job, which caused her to be worried about their finances. Their family is helping to support them. 

Her family genetics involve severe depression in multiple family members going back a few generations, including one person who received ECT and was put into a state hospital for decades. 

Staying with course of her illness, she has definable clinical depressive episodes since age 18, usually lasting about 2-3 months. In between those episodes she always was mildly depressed in mood, but didn't meet full clinical depressive episode definitions. She had not cut herself or made any suicide attempts. She had no dissociative experiences. 

Her clinician saw her as having “complex PTSD” with these multiple life stressors causing her anxiety and depressive symptoms.  Multiple SRIs and amphetamines and benzodiazepines produced limited benefit. Her current medications were citalopram 20 mg/d and Adderall.

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