Q: My 39 years old sister is working in a renowned MNC in America. She has worked on a complex system software development and was very sure about her promotion and bonus as reward. But, the project manager did not recommend her name for promotion and even refused to give bonus to her. All her juniors and other colleagues were appreciated and awarded the bonus. This incident has made her a different person. Before this incident, she used to talk with me, my parents and was a happy person. But now she doesn't even call us and if we call her, she doesn't speak for more than 5 minutes. She feels that people are plotting conspiracy against her. She doesn't even trust her kids and husband. As my parents wants to visit her, she is constantly making some or the other reasons to avoid the visit of my parents. She doesn't even want to visit India. She is not interested in visiting the doctor also as she feels that she is perfectly alright. We are in a state of shock and don't know what to do. After surfing on the net, I find that it's a type of depression. What type of depression is she suffering from? How can it be managed?

A:It is depression and if it is untreated one gets psychotic and that is what makes your sister paranoid. It is vital that she sees a psychiatrist to get help. The first step will be to take her to her primary care doctor and explain the situation to the doctor before she goes for the visit so that the doctor can start her on medicines and recommend that she sees a psychiatrist. She needs to be started on Abilify (15 mg) as it is both an antidepressant and an antipsychotic medication, and later switched to an appropriate maintenance medication by a psychiatrist. Let her be on Abilify for a week or two then her primary care doctor can counsel her to see a psychiatrist and go for therapy to help her cope.