At the CPD, the evidence established the individual had major depressive disorder
and migraines. Medical records indicate depressed mood, decreased energy, suicidal
ideation, sleep disturbance, and diminished interest in activities. The evidence notes
the individual has tried 4 different medications over the last 3 years without meaningful
improvement in symptoms or quality of life. The individual reports sleeping about
3-4 hours per night and napping several times during the day.
Review of the activities of daily living and reports to the medical source indicate
significant problems interacting with others. For example, the individual has groceries
and items delivered rather than going out in public due to their significant fear
of dealing with the public. The individual will not visit family in person and only
sends text messages.
The medical evidence indicates significant problems staying on task, noted by frequent
redirecting in sessions with medical source. Evidence also notes that the individual
was fired from their job three months prior to the CPD for poor performance, crying
episodes, and walking off on customers when questioned or problems came up. The individual’s
supervisor attempted to minimize public interaction by assigning the individual to
work in back room away from the public, but they could not handle simple tasks and
remained off task.
Evidence indicates two hospitalizations for suicidal ideation, one voluntary overnight
stay and one involuntary stay initiated by a concerned family member that resulted
in a three-night hospitalization.
Regarding the individual’s physical impairment, the migraines are controlled and occur
once or twice a month on average. The individual takes over the counter medication