Margaret Chen

Pt reported mood improved ~60% on sertraline 100 + bupropion XL 300. Sleep still fragmented (3–4 awakenings). Denied SI. Anxiety spikes mid-afternoon, work-related. Anhedonia in evenings. No side effects.

Alert and oriented ×3. Well-groomed. Mood 'better.' Affect congruent, full range. Thought process linear, goal-directed. Denies SI/HI/AVH. Insight and judgment intact.

1. MDD, recurrent, moderate — partial remission on sertraline + bupropion. 2. GAD — improving. 3. Insomnia — persistent, considering lamotrigine augmentation.

Continue current regimen × 6w. Add lamotrigine 25mg qhs, titrate per protocol. Sleep hygiene reviewed. RTC 6w. Labs in 3m.

Medications

• Sertraline 100 mg PO qd
• Bupropion XL 300 mg PO qd
• Lamotrigine 25 mg PO qhs — Titrate to 50 mg in 2 weeks
• Hydroxyzine 25 mg PO TID PRN — for anxiety