MB is a 51 year old Caucasian female who came to the office complaining of anxiety, depression, fatigue, and weight gain since the initiation of menopause two years ago (to date she has not had menses for more than 12 consecutive months). She states she just wants to feel better. She lives in Las Vegas, Nevada and came to the city a year ago to be the caretaker for her mother and father. Her mother was diagnosed with Alzheimer’s 4 years ago. MB’s mom is no longer able to cook, drive, and manage a checkbook. MB’s father has COPD and is unable to take over for his wife. It is MB’s responsibility to help her parents manage their day to day lives. She does not live with her parents; she lives with her husband who moved to Las Vegas with her. The move was traumatic. MB and her husband decided that MB needed to be with her mom before Alzheimer’s totally took away her memory. MB and her husband sold their home, made sure their children (who are older) were stable in their situation, and made the move. Unfortunately, leaving her children and having to take care of her parents has caused an incredible amount of stress in MB’s life. She is also struggling with the effects of menopause and has gotten to the point where she feels unable to keep up with everything she is responsible for.
MB has two daughters age 21 and 24. She has a medical history of tubal ligation, ovarian cysts, partial oophorectomy, ETOH abuse with abstinence since 2004, restless leg syndrome for which she takes Klonopin nightly, and cigarette smoking with cessation since 2012. Her current vital signs and lab work are all within normal limits and she appears to be in good health. She enjoys exercise and the outdoors, but admits to not being able to participate in these activities consistently due to her family obligations. She realizes this may be contributing to her stress and weight gain. MB also admits to a possible borderline eating disorder. She is prone to binges but not purging. She has tried most fad diets including Atkins, Zone and South Beach with some success, but re-gained the weight when she resumed unhealthy eating habits. MB struggles with inconsistency in her life, bouncing back and forth between periods of healthy and unhealthy activity. She has received private therapeutic counseling over the past year which helped her feel better, but has been unable to continue this because of financial constraints. MB denies any suicidal or homicidal ideations.
I have diagnosed MB with acute stress reaction, mild depression, obesity, and fatigue. She tells me she does not want to take any medicines for depression. Given her history I am reluctant to prescribe anti-anxiety medications as well. I discussed with MB some alternatives such as meditation, yoga, weight watchers, and continuation of private therapy. MB told me she has tried meditation before with no success. She does like yoga and she has a membership with a gym where she can participate in yoga classes, she just can’t seem to find the time to go. She has also tried weight watchers before and didn’t like it. Private therapy is appealing, but cost is an issue. We discussed all the options and came up with a plan. MB is going to make a commitment to begin yoga classes and make them a regular part of her schedule. She will strive to attend 3 to 5 yoga classes per week to help reduce stress and anxiety. We put together materials from the ChooseMyPlate website and created a nutritional program to help MB eat healthy foods, create healthy eating habits, and hopefully begin to lose weight. We set her weight loss calorie goal at 1500 calories per day. MB is also going to find a way to afford some private counseling sessions (her father will help her with the cost). We determined that this is a crucial aspect to her