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Vitals Blood pressure 139/80, higher then usual Heart rate 84 Respiratory rate 18 Temperature 36C Oxygen saturation 97% on room air General No signs of dehydration No jaundice No pallor No oedema No stigmata of HIV Respiratory No signs of respiratory distress Chest clear, good air entry bilaterally Cardiovascular All pulses present, normal rate, rhythm and character BP higher then normal for this patient No raised JVP Apex beat normally placed No palpable P2, no parasternal heave, no thrills S1, S2 present, no murmurs Abdomen Soft and non tender Bowel sounds present Neurological Higher function intact, orientated to person, place and time No signs of neck stiffness or meningism Gait Could not be assessed as patient unable to walk due to paralysis of lower limbs Cranial nerves No cranial nerve involvement Power Lower limbs- left and right, 0/5 Upper limbs- left and right, 5/5 Tone Lower limbs- left and right, hypotonia Upper limbs-left and right, normal tone Reflexes Lower limbs 0/4, areflexic Upper limbs 2/4 Down going plantars on left and right No primitive reflexes elicited Sensation Intact globally Vibration sense and proprioception Intact globally Day 1 post admission The patient was admitted to the neurological ward and her symptoms continued to worsen

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There has been a long-standing concern, however, that antidepressants may have a role in inducing worsening of depression and the emergence of suicidality in certain patients during the early phases of treatment