The Case of Ms. Blum: Depression, Migraines or PMS

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Problem Statement
Ms. Blum is a 28 year old white female who comes to the pharmacy looking for something to improve her memory and concentration. Sometimes, she is also woken by a severe headache a couple days before her period starts. She does not participate in activities that she used to enjoy, such as spending time with her friends or going tanning. Two weeks later, she has been diagnosed with major depressive disorder, for which, her physician prescribed fluoxetine. Three months later, Ms. Blum returns to the pharmacy with an improvement in depression symptoms. She states that her periods have become irregular. She has begun to exercise regularly and tried, unsuccessfully, to quit smoking. Laboratory work for Ms. Blum shows an elevated level of serum prolactin and no masses or pituitary enlargement.
1. Depression: Ms. Blum first comes to the pharmacy explaining that lately it has been very hard to focus on her work and complete the writing for her dissertation. She also recently broke up with her boyfriend after a 5 year-long relationship. She does not sleep well at night and during the day she does not have much energy.
2. Hormonal Imbalance: The first inclination to this hypothesis was that Ms. Blum was experiencing headaches a couple of days before her period started. She also stated that she did not have the energy that she once did, so this could possibly explain that hypothesis.
3. Migraines: Ms. Blum states that she is sometimes woken up by a severe
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