May 13, 1992

The patient was seen for 30 minutes for medication review and follow-up. His overall affect seemed less depressed and more humorous today although some sarcasm was also present. Although initially drowsy appearing, he was noticeably more awake than he has been on previous visits. He stated he is not taking any of the medications now, having run out about a week ago. While I pointed out he is showing a considerable degree of resistance in not wanting to take the medications, I also agreed we should discuss how he is doing off them. He was taking Nortriptyline, 150 – 200 mg at night, with 300 mg of Lithium Carbonate. Individual, family and academic issues were discussed. He dropped French because he did not feel he could keep up the work and it was not a necessary class for graduation in his degree. On a more positive note, he was pleased that he was offered a full-time job with McDonald's over the summer and he is also building up enough money in his bank account that he may be able to purchase his own computer. I agreed to let him continue off medications over the next two weeks. The issue of how and when to continue individual therapy with him needs to be further addressed. One helpful point today was his recognition that events around him seem to get him depressed. He still has a tendency to blame this on other people although I pointed out now that he recognizes the reaction and the inevitability of other people doing things that disappoint him, he may have to start learning different ways to react to these disappointments in order to decrease his own degree of depression. I will see him again in two weeks.

The Cheese Doctor, M.D.