A second-year girl, who was usually friendly with her classmates, gradually felt that her classmates were talking about her behind her back, badmouthing her, and saying that one of her eyes had offended a certain classmate in a neighboring class, who was a bad student at school, and therefore wanted to harm her. The family took the patient to a psychiatric department of a hospital in Guangzhou, where she was diagnosed with schizophrenia and the physician requested inpatient treatment. After being discharged from the hospital for more than 1 month, the parents reported partial improvement, but the improvement was not significant. After 1 year of suspension, she resumed school in August this year, and at the child’s request, she was transferred from the provincial key middle school she had previously attended to a city-level middle school to repeat her second year of junior high school. After the school year started in mid-August, all the previous symptoms came back gradually, and she didn’t want to go to school again, thinking that she would be safe at home. In early September, she started to see my clinic. Or depression? I couldn’t decide, but I was leaning towards depression. In terms of treatment, I didn’t use alternate medication, I just stopped all her previous medications and switched to the following regimen: Centrum 60mg after dinner and Olanzapine 5mg at bedtime. In addition, the patient complained of chronic stomach pain, so she added Dexedrine half a tablet after breakfast, and her stomach stopped hurting after a few days, and Dexedrine was discontinued after 3 months, and the patient is no longer complaining of stomach pain. After treatment with the above prescription, her condition has improved more obviously, although she is still worried about what her classmates think of her, and she still worries that some bad classmates are going to disadvantage her, especially those who used to be in the same elementary school and are now in the same secondary school. However, she is now willing to go to school, she is able to complete her homework, and her mood is better than before. The parents were satisfied with the results of the treatment and thought that 1 year was now the best. However, the good times did not last long, and in a test in late September, she finished last in the class, far from the bottom two. This time the condition worsened again, suspicion increased again, pessimism is more obvious, also not much willing to go to school, do not want to take high school, and even some anorexic thoughts. The treatment was in a difficult situation. 60mg/day of Cymbalta was the upper limit of the conventional treatment dose, and the patient was still a minor child, so he did not dare to increase the dose. In October, I went to Hunan on a business trip, and one night, the parents called me, complaining that their child had a headache after taking the drug, and I thought it was a side effect of Cymbalta, so I had to call to stop Cymbalta. After stopping Cymbalta, the headache disappeared. One week after discontinuing Cymbalta, the child’s father complained that his condition had worsened, and 2 weeks later, the child’s father still thought that his condition was worsening. At this time, although depressive symptoms were also present, the main clinical phase was psychotic symptoms such as hypochondriasis and victimization. Was it schizophrenia? Or was it depression? I decided to treat with antidepressants alone, which had the advantage of helping to clarify the diagnosis. So I stopped the olanzapine and re-treated with Cymbalta. This time I finally used the right medication and my condition has been improving ever since. In the past 2 months or so, the condition has not fluctuated, and now, he likes to go to school and laugh with his classmates. For example, she still lacks confidence in studying in high school and university, and wants to go to a technical school in the future. In addition, she has some worries because she is laughing and talking with her classmates now, but when she first entered this school, she did not say anything and did not care about people. In order to promote further improvement, I increased the patient’s Cymbalta to 90mg/day last week, taking into account the fact that there had been no adverse drug reactions to Cymbalta for more than 2 months. At this point, the diagnosis has also been clarified as depression, which is currently depression with psychotic symptoms.