Ebtisam is a 35-year-old widowed mother of a teenage daughter who moved from the country to the city five years ago. Ebtisam works as an administration assistant in a public relations company.

She presents today with a four-week history of depressed mood, loss of interest, weight gain and insomnia. She cannot identify any recent life stresses to account for her change in mood. She is now unable to function effectively at work and is concerned for her daughter in the event of her illness progressing.

Ebtisam says "I had this once before". She describes a single episode of major depression twenty years ago, which was treated, with a twelve-month course of antidepressants.

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