January 9, 1991

The patient was seen by myself for approximately 60 minutes. Since he was hospitalized at Providence Medical Center, I saw him for 30 minutes last week at the ABC Family Service office in Prineville and that note is being forwarded. We are also awaiting his discharge summary from Providence Hospital. While at Providence Hospital, he was started on nortriptyline 75 mg at bedtime. He was also tried on doses as high as 100 mg but this was over-sedating. He appears to be sleeping well on the 75 mg and is continuing to show improvement in his depression, but he is having complaints of fairly severe dry mouth and some constipation. For this reason, I agreed that if he were going to continue on 75 mg of nortriptyline a day, he could try Bethanecol 10 mg up to four times daily as needed for dry mouth. Although he initially was somewhat reticent to speak during this session and described the week as boring, he gradually opened up during the session, talking about literature that he likes and in particular the Hitchhikers Guide to the Galaxy series by the British author Douglas Adams. This provided some basis of discussion in order to continue conversation throughout the session. He was also able to talk more about family interactions and his feeling that things were going better. He had one day when he felt very depressed prior to seeing me last week. He felt things in general had been better, although when I saw his mother she commented that he was also depressed three days ago on a Sunday when his sister visited from California for the day. He said that he had forgotten about this but also indicated that he was feeling better. He also speaks more aobut interactions with friends and the activities that he is doing with the circle of friends that he normally spends time with, which in general sounds positive. I would like to see him again for another hour next week.

The Cheese Man,