| T: hi-oh Vina how are you doing today it's good to see you | |
| C: I'm just tired | |
| T: just tired yeah you know we did some pre-visit planning with you and your phq- which is a short depression screen was actually positive so we asked the nurse to give you a little longer screening tool which is a phq- and that actually did come up with a score of which is in the mild depression range so how does that how does that feel | |
| C: well I knew I felt different I didn't know I was depressed | |
| T: but you knew something was something was wrong | |
| C: I didn't feel like myself or have it and feeling like myself no | |
| T: tell me a little bit more about not feeling like yourself | |
| C: when I just go to work and I come home and I sleep I wake up in the morning and I'm still tired I just have no energy | |
| T: so you sleep a lot but even though you're sleeping you don't wake up rested no not at all doesn't sound like good quality sleep | |
| C: no I just have no energy I don't want to do anything but just sleep | |
| T: how long has | |
| C: that been going on hmm I guess a couple months or months yeah | |
| T: what else is going on | |
| C: w-well you know I been drinking more I'm a drink socially but I find myself that when I come home you know I have a glass of wine and then I just go to sleep | |
| T: and that's worrisome to you | |
| C: it is cuz I don't usually drink that often during the week so it's increased yeah yeah | |
| T: I can see where that would be bothersome to you what else what else is going on with | |
| C: you well you know my mom died a year ago so Mother's Day is coming up so you never think about mom a lot I miss her a lot | |
| T: that anniversary is is close | |
| C: yeah | |
| T: that's particularly hard when those anniversaries come around for the passings of our parents that's a that's a very difficult time I | |
| C: yeah and I took care of mom so that's hard because for a long time well she was sick and she died from cancer so I took care of her so for a long time that's all I did was take care of mom and work that was so now that she's gone it just kind of brings up everything all over again | |
| T: it's kind of a hole in your life | |
| C: yeah we were really close | |
| T: I'm really sorry for your loss and thank you for sharing that with me I know that's I know that's very difficult so it sounds like your sleep has really been affected you're not getting good quality sleep you're really fatigued yeah I'm just kind of going through the motions it sounds like during the day and then how's your appetite been | |
| C: I'm not really eating that much you know so I have energy you know before I would come home cook dinner or you know meet some friends after work but I don't want to do that I just come home and have a glass of wine just go to bed | |
| T: so you used to be more socially involved than you are now | |
| C: yeah don't do anything now a little T; more isolated | |
| C: yeah just working come home and sleep | |
| T: so if there was something that you could do about this what do you think you might like to do | |
| C: well I don't want to stay like this this isn't Who I am you know just sleeping all the time this is I don't want to stay this way | |
| T: kind of feels like you're stuck yes point | |
| C: yeah I just don't want to do anything or go out my friends anymore and just work and come home and sleep I don't want to do that | |
| T: it's kind of the same old routine um I wonder if it would be okay if we could talk about some of the options that are out there for folks that have some mild depression | |
| C: okay | |
| T: like you would that be alright most of the time we typically think about medication as a as a possible answer so no medication at this point ation | |
| C: no | |
| T: all right then I think as important certainly perhaps more important than medication is counseling and getting you to talk with someone about your feelings on a regular basis and getting some feedback on that | |
| C: I'm okay with that you know when Mom was sick you know she was in hospice care so she had cancer and the nurses and the doctors you know had our family talked to someone you know about what we were feeling you know | |
| T: so that was the face pretty good experience | |
| C: yeah yeah to talk to someone that understood what we were going through sure | |
| T: something else might be exercised another possibility would be a natural product there are some things over the counter that I think for mild depression may be appropriate and those that's another thing that we could talk about if you wanted to learn a little bit more about those | |
| C: may be something natural exercise I don't have energy I don't want to I just don't feel like doing anything so I know I'm not going to exercise right now but if it's something that's natural you know I can maybe try that | |
| T: okay if it's okay let's go back to talking about the counseling for a minute and then we can hit some of those other things too okay so um is there a counselor that you know or that you have a relationship with this lady that worked with you during your mom's death is she you don't want us out in the community | |
| C: she was really nice for me yeah I liked her | |
| T: so it sounds like you're pretty ready to do that could you say on a scale of zero to ten ten being really ready zero being not ready at all how ready would you be to do some counselling | |
| C: maybe like a six or seven | |
| T: so a six or seven why a six or seven and not a four or a five | |
| C: well because I don't want to stay like this and you know I've already talked to her before she was really nice so I wouldn't mind going back to her and she told me you know when I saw her last time if ever needed I could come back | |
| T: so it sounds like you've got a connection there already that's really good yeah um does that sound like something you're ready to do then and maybe make a plan about that yeah I can definitely check with her and see if she can see me again okay yeah | |
| T: well that's okay then it would be all right if we talked a little bit about the exercise I know you said that didn't really sound like an option for you at this time and that's perfectly fine only you can make those decisions Alvina but if it's okay I wanted to give you a little bit of information about exercise and its effect on the brain okay exercises is again a number of studies has been shown to be as effective as prescription antidepressants okay I didn't know that yeah it actually raises serotonin have you heard about serotonin yeah I asked kind of the happy hormone yes so um it actually raises serotonin and also something called BDNF which is well it doesn't really matter what it is but it helps actually your your brain actually grow and help repair itself so exercise can help in lots of ways by improving serotonin and decreasing stress certainly and in actually improving the quality of sleep how does that sound at this point | |
| C: well if I try to exercise and if I call her to talk to her again does that mean I have to run the medication | |
| T: right now we can try that absolutely again those are yours to sit your decisions and I'm I'm here to really support you in those so if those sound like things that you might be willing to do I'm I'm all for it well I'll try then let's go on the medication | |
| C: okay I have some friends they exercise and workout that I could probably call and exercise with them | |
| T: so you have some friends that are already involved in an exercise program yeah is that something you talk with them about and that you possibly could get into that group | |
| C: yeah I have friends that run and friends that go to gym I have some friends that walk after work | |
| T: so it sounds like a wide variety of things that you could do yeah which of those tend to interest you most | |
| C: well then also you know my church on the weekends they have exercise classes too so yeah but I think I guess I don't have energy really to exercise but I'll try it but I'll definitely call the person I had talked to a mom passed away and I'll do that right away | |
| T: very good well I think it sounds like this is important for you to to feel better and it sounds like you're really ready to kind of make a plan how do you see this fitting into your life at this point again kind of getting back to the counseling and and the exercise | |
| C: well when I saw her I could see her after work so I can call her and see if I can still see her after work for therapy and exercise I mean I can do that you know after work or on the weekends my friends they exercise various time so | |
| T: yeah let's talk a little bit more about that you're say on a scale of if we can do use another one of those scales zero being confident that you could start an exercise program zero being not very confident at all in being very confident tell me where you are in this exercise thing | |
| C: honestly maybe a five okay and I'll try it it say if I have to do that so I have to go on medication then I'll try it okay that | |
| T: sounds like a pretty strong commitment yes I'll try it | |
| T: okay and tell me a little bit more about your plan for exercise at this point | |
| C: then well you know my friends have been calling but you know I'm just sleeping all the time so when they call them sleep so I haven't really called them back but I know I can just return their calls and just let them know I'll want to meet up with them and you know at least maybe just start walking | |
| T: I think that's a great decision you have a couple of friends in mind that you could call | |
| C: yeah real close close friends that live not too far from me yeah so tell me how to | |
| T: tell me about a plan that you would think could perhaps get you going with with the exercise | |
| C: well I probably shouldn't come home I probably would need to call one of my friends and make a plan to maybe walk after work and take a change of clothes and maybe drive to one of my friends house after work and change with her | |
| T: it would be difficult to do it in the morning you don't see that happening | |
| C: no because it's so hard when I get up in the room so tired that I can't I can't say doing in the morning | |
| T: you think it would be easier to do it after work | |
| C: cuz I'm already out yeah as long as I don't come home so I come on Monica's sleep come home it's over yeah yeah all right | |
| T: well good it sounds like we have a plan for the counselor and when you check out today I will put this in your record and that will want to get in touch with the counselor that you work with when your mom was going through okay her passing in the grief situation and then I'll want to depend upon you to call your friends and then get involved in the exercise program | |
| C: okay I'll try that | |
| T: all right and if it's okay I'd like to call you in a week to one see how you're feeling and to the exercise is helping you may really find that after you give the exercise a good trial you may actually look forward to it because my hope is that will actually help you feel better and improve your mood and then I would also like to see you back in two weeks just to check on things now we've talked about exercise apartment we've talked about medication not being on the table at this point but I want you to know you know you can call anytime and I will work to get you in and that might be something that we need to do if our plan is not working okay |