PRADER, BRACKER, & ASSOCIATES A Complete Health Care Facility 159 Healthcare Way • SOMEWHERE, FL 32811 • 407-555-6789 PATIENT: FALCONE, ANTONIO ACCOUNT/EHR #: FALANT001 DATE: Attending Physician: Renee O. Bracker, MD Antonio, a 43-year-old male, was referred by his therapist of 3 years, Ms. Benton, for psychiatric evaluation and consideration of medication to treat worsening depression. At the initial interview, Antonio’s wife, Marie, an attorney, was present to provide some history and perceptions. She was quite cooperative yet strangely detached. She answered all of the questions that I asked in a genuine manner. All pathological causes of sadness have been ruled out. A complete workup is performed. It gradually became clear that the source of Antonio’s persistent depression was his wife’s lack of accountability and responsibility in the marriage. She was frequently late for sessions, with no notice. Antonio always wanted to be a family man. Marie refuses to work at the marriage, crushing Antonio’s expectations of a satisfying marriage. Antonio checked into a hotel 500 miles away from home and threatened suicide 2 days ago. When Antonio returned, he came directly to my office. This episode was due to his wife’s lack of therapy participation. Antonio stated he feels like a failure because he can’t make the marriage work. Suicide seemed to be a viable exit strategy from the pain. My recommendations were that an environment change was needed to recover from the suicidal ideation. Antonio was experiencing continued depression caused by this environment in which his level of control over the outcome was minimal. This led to more severe and frequent depression. I advised him to stay out of the house. Diagnosis: Major depressive disorder, recurrent, moderate