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February 14, 1996

A 47-Year-Old Man With Chronic Depression

JAMA. 1996;275(6):479-485. doi:10.1001/jama.1996.03530300063042

Dr Delbanco:  Mr N is a 47-year-old man who has struggled with depression for approximately 15 years. Divorced from his first wife and now separated from his second, he is the father of two teenaged children. He works for a local human service institution and receives private managed care health insurance through his employer.At 32 years of age, Mr N sought marriage counseling with his first wife. After his marriage ended, he continued with individual counseling; a diagnosis of depression was established, and he began taking an antidepressant he believes to have been imipramine. In 1980, he moved to Massachusetts and was denied coverage for individual psychotherapy by his new health plan. He was offered group counseling but after three meetings found it an inappropriate setting for his problems.Between 1983 and 1984, Mr N felt markedly worse and quit his job. During this time his divorce became final.