Ms. Reed is a 45 year-old woman with a history of chronic atopic dermatitis, which started when she was in college. At first, she reportedly experienced episodes of patchy, itchy red bumps on the extensor aspects of her arms, legs, and such episodes would get worse during exam periods. After college, she had ten blissful years without any significant atopic dermatitis episodes. However, the disease has been making a return in the past 12–13 years, gradually at first but then picking up speed in terms of frequency and viciousness of each episode. Today, the patient comes in with both arms and legs studded circumferentially with eczematous papules, which appear beefy red and noticeably warm to the touch. She reports still using her triamcinolone acetonide 0.1 % cream and emollients to the affected areas daily. You have never observed such inflammatory intensity with her skin disease before.

When you take a step back to appreciate her overall mood and mannerism, she appears out of the ordinary. Her speech is delayed, as is her comprehension of simple language from you. She admits to feeling tired for the past month and being unable to fall asleep, even at night. You ask if she has lost weight, to which she answers, “I’m not sure, but I don’t have much of an appetite these days.” “And,” she adds, “my mood fluctuates a lot throughout a normal, uneventful day. Sometimes I get really sad and cry for no reason, and all of a sudden, I can just feel okay.” You wonder if this patient is depressed, based on her presenting signs and symptoms. Upon further questioning, Ms. Reed tells you that her husband is out of work, which makes things much worse at home because they have had marital problems for several years, and financial stability was the only thing keeping their family together. She is now visibly crying, and you reach for facial tissues to offer her.