Further History
Omar is admitted to hospital with a diagnosis of major depressive disorders with psychotic features and treated with fluoxetine (Prozac), which is titrated to 40 mg over a 10-day period. He makes a dramatic recovery and is discharged after three weeks. The fluoxetine is continued for the next twelve months and then gradually discontinued.

A year later, he graduates as a civil engineer. Two years after that, he is brought in by his wife (of six months). She says that over the last two days she has noticed a marked increase in his energy level and speed and frequency of his speech. People at his work have complained that he was being intrusive, irritable, and silly.

Omar says that he has never felt better. He feels "exploding with creativity and confidence," and as if a laser beam has transformed his sluggish thoughts, recharging them, galvanising them. During the visit he maintains a constant banter of jocularity and witticisms, and makes thinly veiled attempts to seduce the practice receptionist.

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