Using the case study below, answer the following questions in a narrative form.

1. What would you diagnose the client with? Please provide justification and ensure you use proper specifiers.

2. What are the differentials that you would consider?

3. What would your treatment recommendations be? (is there a certain theory you'd use? Would you suggest individuals, families, couples, etc? Would you suggest medication and if so what would you think a prescriber would prescribe?). Please ensure you explain why you chose the recommendations you did. Include the new DSM V Codes

Gerhard Palmer, a 55-year-old married accountant, presented to a psychiatrist for a second opinion in the context of recurrent major depression. He had not responded to two 3-month antidepressant trials, one with fluoxetine and another with sertraline, both at high dosages. He had not been taking medications for about a month following the last failed trial.

The evaluation revealed a severely depressed man with profound psychomotor retardation, poor concentration, early insomnia, mildly diminished libido, and anhedonia. Mr. Palmer denied substance abuse, drank minimally, and did not smoke. He had started taking propranolol for hypertension about 6 months previously. His physical examination was unremarkable. Basic laboratory tests were within normal limits. His blood pressure was 135/85.

Treatment with clomipramine was initiated, and the dose was quickly titrated to 250 mg/day. Buspirone 30 mg/day was added. After 5 weeks of treatment, Mr. Palmer reported feeling much improved. He was sleeping and eating well, was participating in enjoyable activities with increasing enthusiasm, and, for the first time in many months, felt a return of his sexual interest.

After not having had sexual intercourse in months, Mr. Palmer tried unsuccessfully to have sex several times. He was distressed to find that for the first time in his life, he was unable to maintain an erection during intercourse and was unable to ejaculate, even during masturbation. These problems persisted for a month. He recalled having had slightly delayed ejaculation while taking fluoxetine. He did not recall sexual problems during a prior trial of bupropion.