Mary is a 52-year-old female that comes into the clinic as a…

Mary is a 52-year-old female that comes into the clinic as a referral from her PCP. She has been on fluoxetine, sertraline, escitalopram and duloxetine for her anxiety and it made her symptoms worse and more irritable. When talking with her she has had periods in her life where she was on top of the world. Could do anything and felt like she was the best out there. Her thoughts would race, she would be more talkative, did not need to really sleep due to all the ideas that she was having. She has had this last greater than 4 days but no more than 6 days. The symptoms did not greatly impact her life and was able to hold a job but completely noticeable to others. She will then hit a major depression that is debilitating and has had to take off of work due to the depressive episodes. What criteria does she fit best: 

Mary is a 17-year-old female that comes to the clinic with c…

Mary is a 17-year-old female that comes to the clinic with concerns of depression. She has been depressed for greater than two years and she has not felt relief from this depression for greater than two months. You diagnose her with persistent depressive disorder and start her on fluoxetine. She presents back to the clinic in one month and she is chipper, much happier and states she has not felt this good in years and has started different projects and feels like she has so much energy she does not need to sleep. She is also wearing generous amounts of makeup and not dressed for the weather. What is something to consider with this presentation: