Mental Health Evaluation: Depression, ADHD considerations, trauma history, and treatment plan

Age: $23$
Status: 23-year-old nursing student; currently out-of-state; long-term partner; no children; planning to become an RN; interest in psychology; currently evaluating mental health care.

Depression identified on screening; significant focus and ADHD symptoms concerns; desires formal ADHD assessment and medication management; has therapy appointment tomorrow; wants professional feedback and diagnosis to guide treatment.

Childhood trauma: raped at $14$ ; memory affected by past substances; extensive therapy for childhood trauma; ongoing processing; journaling to cope; impact on sexual functioning.
Family history: mother with mood swings; possible narcissistic traits; father with anxiety; no formal diagnoses.

Past cocaine use (not current); mushrooms/psilocybin experimented with; currently not using substances regularly; no current suicidal/homicidal ideation; has housing and a primary partner support system.

In college studying nursing; aims to obtain $RN$ license; potential future in psychology/therapy; bachelor's in psychology; bridge program; pragmatic plan to pursue clinical psychology work after nursing.

Clinician perspective: ADHD is widely discussed; screening is time-limited and not used to formally diagnose at intake; concern about medication misuse in broader population.
Treatment options discussed: non-stimulants (guanfacine, atomoxetine/Strattera); Wellbutrin ( $bupropion$ ) discussed for ADHD symptoms, anxiety, and depression; caution that Wellbutrin can worsen anxiety in some patients; stimulants like Adderall typically not prescribed here.
Patient preference: seeks formal ADHD assessment to confirm diagnosis; open to Tri-State assessment; if diagnosed, non-stimulant options may be used.

Wellbutrin (bupropion): 1 tablet in the morning; $15$ -day supply; follow-up in about $1\,\text{month}$ ; expected changes typically after $2-4\,\text{weeks}$ if effective.
Hydroxyzine: $25\,\text{mg}$ ; 1 capsule at bedtime as needed for anxiety; can be used for sleep; caution about sedation.
Notes: will monitor response; plan to pursue ADHD assessment; potential adjustments based on diagnostic results.

Request for formal ADHD assessment; a note will be sent to the patient’s current therapist; follow-up planned in about $1\,\text{month}$ .
Pharmacy preference: Seattle Walgreens Specialty Pharmacy.

No current suicidal or homicidal ideation; housing secured; primary support from long-term partner; not homeless.

ADHD diagnosis often contested due to population-wide demand and risk of medication misuse; emphasis on careful screening within time constraints and consideration of non-stimulants first; patient education and collaborative planning emphasized.