45-year-old male who has been married for 15 years with 2 children. He has a history of MDD and pornography addiction which has been dealt with through therapy. This addiction had caused some trouble in the marriage but for the past 5 years, things have been going well in the marriage and patient denied looking at porn. MDD symptoms started in his 20s and have been well managed with citalopram (Celexa) 20mg daily. He comes in today visibly upset. He reports his wife has been cheating on him for 2 years and he found out when he came home from work to find his wife and kids gone, a note that detailed her infidelity and she took the children to live with the man she has been cheating with. Divorce proceedings are in effect. He states “I had no idea, I know I had my own problems but 2 years? I feel so stupid, I don’t know why I bothered improving myself, I don’t know how I can even go on. My work made me take some time off but I have continued to call in, I’m at risk of losing my job but I just can’t bring myself to go. The kids are my world and I haven’t even talked to them for a month”. You question him about suicidal or homicidal ideations and he replies that he has been suicidal since she left and has been drinking “at least a 6 pack” a night. He has had plans to shoot himself. When asked what is keeping him from acting on plans he said “My kids but I’m losing hope I’ll ever see or talk to them again”. What are your next steps?
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