A 37-year-old woman presents to establish care with you in the office today. She complains of low energy levels and difficulty sleeping for the past 4 years. She has gained 30 lb over the past 2 years. She reports a family history of alcoholism in her mother and her older brother, and completed suicide in her father. She thinks her mother was hospitalized for a suicide attempt many years ago, but she does not know any more details. When you ask about her social history, she hesitates in giving her answer, and then becomes tearful as she tells you with great difficulty that she was in a physically and sexually abusive marriage for 10 years. The marriage finally ended over 1 year ago, but the patient still expresses guilt about its end and says she feels worthless every day. She admits that she had suicidal thoughts on and off in the past but has none currently. She has never had a suicide attempt. She drinks 3 beers nightly. Her vital signs and complete physical examination are normal except for a labile affect.
1. What is the most likely diagnosis?
2. What is the next appropriate step in evaluation?
3. What therapeutic options can you offer to this patient?
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