December 11, 1991

The patient was seen for 30 minutes for medication review and follow-up. He showed up an hour earlier than I expected but it was during a break and I was able to see him. His level of depression remains about the same but not worse than when I saw him two weeks ago. I felt like there was an increase in his overall withdrawal and difficulty talking and that his affect was more depressed, despite his report. Discouragement about his relationship with friends and family is also somewhat increased. He is not sleeping as well again, so I recommended we increase his Nortriptyline to a full 150 mg a night while continuing him on 50 mg of Desipramine during the day. It may make the most sense to shift the dosage entirely over to Nortriptyline at night if he is having sleep disturbance.

The Cheese Doctor, M.D.