DR DALEY: Ms V
is a 45-year-old office worker and
mother of 2 adolescents with a long history of premenstrual syndrome
(PMS). She lives in a suburb of Boston, Mass, and has commercial
Ms V experienced menarche at age 16 years and is gravida 2,
para 2, abortas 0. Her menstrual periods were irregular for many years.
She recalls mood swings, irritability, and feeling overwhelmed and
depressed prior to menses since her menarche, although she states that
it was only in retrospect that she recognized her symptoms corresponded
to the 7 to 10 days prior to her menses. During her 2 pregnancies and
the 2 years in which she breast-fed her children after each pregnancy,
her cyclical symptoms were much better. During her 20s, diazepam was
prescribed to improve her symptoms, but the medication made her feel
more depressed. During her 30s, a gynecologist prescribed several oral
contraceptive agents, which made Ms V feel suicidal, very vulnerable,
and "weepy" all the time. Subsequently, dietary modification,
vitamins, and exercise were recommended; Ms V tried each of these
without improvement in her cyclic symptoms. Alprazolam was prescribed
and "made the crying and depressive feelings much worse."
Progesterone was never prescribed. She had a tubal ligation in 1984.
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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and
Association With Material Stature
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dhildhood mortality and growth failure data and their association with maternal
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The Rational Clinical Examination
Make the Diagnosis: Depression
The Rational Clinical Examination
Original Article: Is This Patient Clinically Depressed?
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