January 15, 1992

The patient arrived about 5 minutes late for his 45 minute appointment and was seen for a total of approximately 40 minutes. He expresses continued discouragement about school and his personal life. He talked about difficulty getting along with people but also about his anger that other people did not seem to treat him as he wished. He had a major argument with his mother two days ago when she came in questioning him about hi depression and asking him if he had taken his medication. He feels like his mother doesn't trust him or doesn't think he is old enough to remember to take his medication when she questions him. After he got angry with her, other family members and friends became angry with him over the way he treated her. We talked about the anger he felt towards friends as well during these circumstances. While on the one hand he feels the self esteem is really low and he cannot get along with people, he also continues to be angry that other people do not treat him with as much respect as he feels they give others. He has been taking 150 mg of Nortriptyline at night but is not sleeping through the night. He is, nonetheless, sleepy during the day from lack of sleep during the night. He is still taking 300 mg of Lithium Carbonate twice daily. I elected to raise both medications, increasing the Nortriptyline to 200 mg a night, while increasing the Lithium Carbonate to 300 mg in the morning and 600 mg at night. I will see him again in one week for an additional hour and will get a serum lithium level at that time.

The Cheese Man, M.D.