Psychiatric Consultation Notes
The Cheese Man, M.D.
December 6th, 1990

The patient was seen for 40 minutes for individual therapy and medication review. We talked about issues related to problems he was having talking to a therapist and conversation in general. He feels that his overall mood has improved somewhat in the last couple of days, although there have been ups and downs. He is sleeping somewhat excessively and is still quite tired in the morning. I asked that he drop his Doxepin does back from 20 mg to 10 mg at night while continuing on Prozac 40 mg during the day. He is also complaining of some shakiness during the day, which he noticed during his welding class. This may be related to Prozac but also may be related to the Doxepin as well, which tends to raise epinephrine levels. He is avoiding caffeinated beverages for the most part, so I do not think that is the problem. I would prefer to watch it for another week because I would rather have him on higher dose of Prozac for a while, until he shows more signs that his depression is improving. I spoke with Dr. T's office and Dr. T did not believe a T4 or TSH has been done. I gave the patient a lab slip for a T4, TSH, CBC, Fasting Chemistry screen and UA to be done if none had been done in the last month.

I will see him at my private office on December 12.

The Cheese Man, M.D.