1st March 2024

A 54-year-old woman has attended her GP as she has been struggling to sleep for the last few months.

A 54-year-old woman has attended her GP as she has been struggling to sleep for the last few months. She finds she lies awake at night for long periods of time before she is able to fall asleep. She has recently lost her job in HR, as she was struggling to concentrate – and put this down to her “brain fog” from the menopause. She now rarely sees people as she doesn’t like to leave the house. Her children have all recently left for university, so she lives alone. She has never had a huge appetite, but now struggles to have one meal a day. She used to enjoy going swimming but now feels she is too tired to do this. She has not experienced any periods of elation or had any suicidal ideation but she has harmed herself previously, with cigarette burns. There is no family history of any mental health disorders. She has a past medical history of hypertension which is well controlled, and also takes HRT for postmenopausal symptoms of hot flushes and vaginal dryness. She has previously taken sertraline, but experienced unpleasant nausea and vomiting.

On assessment, her PHQ-9 score is 16.

Please prescribe an appropriate treatment for her.