Hi,
As per her history before proceeding to
depression let us ruled out major causes responsible for
fatigue as you have already ruled out something so follow as below:
1) Add vitamin B-12 injection 3-4 times weekly in IM for upto one month and then once a month.
2) Do blood DC and
ESR & Tuberculin test
3) Do RF/ASO to ruled out
rheumatoid arthritis.
4) Do ECG/ECHO to ruled out heart valve disorders
5) Record her period of last 6 months.
Check depression as per this chart:
1) Doing things slowly- Yes/no
2) She feels her future is hopeless-yes/no
3) It is hard for her to concentrate on reading-yes/no
4) She feels that the pleasure and joy has gone out of her life-Yes/No
5) She has difficulty making decisions.-Yes/No
6) She has lost interest in aspects of life that used to be important to her-Yes/No
7) She feels sad, blue, and unhappy sometimes -Yes/No
8) Sometimes she is agitated and keep moving around-Yes/No
9) She feels fatigued-Yes/No
10) It takes great effort for her to do simple things-Yes/No
11) She feels that she is a guilty person who deserves to be punished-Yes/No
12) She feels like a failure.-Yes/No
13) She feels lifeless -- more dead than alive.-Yes/No
14) Her sleep has been disturbed -- too little, too much, or broken sleep.-Yes/No
15) She spends time thinking about HOW she might kill myself.-Yes/No
16) She feels trapped or caught.-Yes/No
17) She feels depressed even when good things happen to her-Yes/No
18) Without trying to diet, she has lost, or gained, weight.-Yes/No
)Check whether she has >5 YES present or not if present she needs medications for it. Follow me with test report after 30 days.
I hope I was able to address your query. If you have any further questions, please do not hesitate to write to me. Wishing you all the best.
Thanks,
Dr. Uday Nath Sahoo