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A 29-year old woman who is three months postpartum with her fifth child comes to the clinic to talk about her worsening depression.  You have cared for this woman over the years, most recently for her prenatal care and delivery. During that time she took herself off all psych/mental health drugs which included Zoloft 100mg and buspar 15mg TID for anxiety.  She is a long term pot smoker at least 2 x a day and smoked pot during her pregnancy for nausea. You counseled her several time to stop. She had a stable pregnancy and did not have any symptoms of depression during the pregnancy.  She is married to the father of all of her children and has a good relationship with him. Lately she has been more withdrawn at home and wants to just stay in her room with the baby all day. In a bipolar assessment of her symptoms (MDQ) screening questionnaire, she scored very high on the bipolar scale.  You know that her previous meds have not helped her symptoms and she goes though time when she cannot sleep for weeks at a time.

CC: I get sad and angry a lot during the day even at the children and I love my kids and always strive to be a good mom. I just want to feel better!


1. What are the important elements to the description of her depression and why?

2. Does this meet the DMV 5 definition of major depression?  Why or why not?

3. What else might you want to know from this patient?

4. What is her differential diagnosis and what is the most like diagnosis?

5. Describe the plan of care for this patient.

6. Discuss the difference of major depression and bipolar disease in women.


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