A 37-year-old woman presents to her general practitioner complaining feeling ‘tired all the time’. This has been over the last 6 months and she believes it is related to coping with her three children aged 12, 7 and 5. She says that her self-esteem has been low recently and this has been made worse by having no work (she was a nurse before she had children). It is also related to gradual weight gain. Her husband is supportive. She says she has found it increasingly difficult to concentrate.
She has been weepy recently but has no thoughts of self-harm or harm to others. On systematic inquiry of her health, there is nothing except a history of constipation, which she puts down to lethargy and lack of exercise. She also has heavy periods. She is sleeping well and sometimes feels dull after sleep. She can enjoy herself and says she enjoys her food, and indeed has put on a few pounds…
