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A successful middle-aged businessman presented with a one-year history of marked anxiety and insomnia -- symptoms quite out of character for him.

These appeared to have developed in the context of business difficulties out of his control. This had led to the necessity to lay off a large number of long-serving loyal staff, a task he found very difficult.

Closer questioning revealed that the insomnia and anxiety were manifestations of major depression. Whereas he usually thrived on work, he found himself reluctant to go to the office. He had also lost interest in his golf, and did not enjoy his holidays. He had become forgetful, for example paying for goods in a shop and then leaving without them. His concentration had become impaired, which made it difficult for him to read documents.

He had never been depressed previously. Apart from a benign enlarged prostate his physical health had been good. He did not abuse alcohol or other substances. There was no evidence of any marital or family problems.

In view of the disabling nature of his depression, he was prescribed a selective serotonin reuptake inhibitor (SSRI), with a marked improvement of his symptoms over the next month. As he recovered, his usual ability to deal with work pressures returned. However, his symptoms recurred when withdrawal of the SSRI was attempted nine months later, so he has continued drug treatment.

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