Patient evaluation on intake

• 57-year-old man with a chief complaint of “horrible depression”

• Feels he “made a bad decision” late in his career and is now unemployed after many successful years in equipment sales

• Fearful and nervous that, at his age, he is too young to retire and too old to find a new job and be successful again Psychiatric history

• He had been without major mental health issues until he left his gainful employment of 25 years as an equipment salesman

• – He left during poor corporate economic times assuming his company would fold

• – He left for a second company for a sales position in a different market, and performed poorly on commission and was let go

• – Psychiatric symptoms developed after this

• Has not been able to go back to work at all due to anxiety and fear about failing again

• He admits to full syndromal depressive symptoms

• – He has passive suicidal thoughts and ideational guilt that he is a bad spouse in that he has let his family down by being unsuccessful and unemployed

• – Additionally, he is amotivated, fatigued, and states he is hopeless and pessimistic about the future

• He now worries about everything, all the time, cannot focus, and is tense. He states he was never like this before

• Additionally, he can barely “look people in the eye” and talk to them

• – He is very concerned about doing and saying the right thing

• – After years of remembering many details in sales, he can barely keep any facts straight, and is convinced that he will fail

• – Panic attacks have occurred at recent job interviews, and since then is avoiding most situations where he has to speak to superiors

• He has relatively few friends as most were colleagues at his previous job

• While he is at home more, he is experiencing more conflict with his wife, although states she is supportive