ABSTRACT
A 37-year-old woman presents to her general practitioner (GP) complaining of feeling ‘tired all the time’. This has come on over the last 6 months and she believes it is related to coping with three children ages 12, 7 and 5. She says that her self-esteem has been low recently and this is made worse by having no work (she was a nurse before she had children). It is also related to gradual weight gain. Her husband is supportive. She says she has found it increasingly difficult to concentrate. She has been weepy recently but has no thoughts of self-harm or harm to others. On systematic enquiry of her health, there is nothing of note except a history of constipation, which she puts down to lethargy and lack of exercise. She also has heavy periods. She is sleeping well, and sometimes feels unrefreshed by sleep. She can enjoy herself, and says she enjoys her food, and indeed has put on a few pounds recently.
