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Depression [F32.9] is a mental health mood disorder distinguished by feelings of persistent intensified sadness, fatigue, lack of pleasure in various activities/interest, and unfulfillment (Chand & Arif, 2023). It has the potential to affect an individual’s cognitive thought processes, behavior, emotions, and overall physical condition. According to Chand and Arif (2023), it is worth acknowledging that the experience of depression can vary among individuals, and not all symptoms may manifest for every patient. Given the 28-year old patient’s presenting signs and symptoms of fatigue, increased sleep, and weight gain with additional history of unmanaged depression since 17 years old, an acute episode of depression is likely the root of the problem. In addition, the female gender is more susceptible to depression. According to Chand & Arif (2023), females experience higher rates of depression than males in early adolescence. Recognizing that depression is a complex mood disorder, a thorough evaluation that considers physical, psychological, and social aspects becomes crucial for an accurate diagnosis. While there are no definitive laboratory test available that can diagnose depression, blood tests such as thyroid function aid in identifying underlying medical conditions that can contribute to depressive symptoms, such as thyroid disorders (TSH, T4) as well as testing for vitamin and electrolyte levels since imbalances contribute to disruption of mood and overall health (Chand & Arif, 2023). Other than depression, another differential diagnosis to consider for this patient includes hypothyroidism [E03.9], which occurs when the thyroid gland does not make enough thyroid hormones to meet the body’s needs (Patil et al., 2023). Common symptoms of hypothyroidism include fatigue, depression, weight gain, joint muscle pain, dry skin, and cold intolerance. It’s important to check the patient’s thyroid hormones to rule out possible hypothyroidism.
When treating for depression, it usually consists of blending strategies customized to match the individual’s preferences, needs, requirements, and the intensity of their symptoms. According to Chand and Arif (2023), solely using medication (such as first-line medications SSRI’s–SSRIs offer the benefit of ease of dosing and minimal toxicity in cases of overdose) and psychotherapy (such as cognitive-behavioral therapy or interpersonal therapy) relieves depressive symptoms. Blending therapies and whilst consistently adhering to prescribed medication has also shown notably increased rates of improvement in depressive symptoms, elevated quality of life, and improved adherence to treatment. There’s also evidence for cognitive-behavioral therapy’s (CBT) capacity to prevent relapses (Chand & Arif, 2023).
1. Major Depressive Disorder (MDD): unipolar depression, also known as Major Depressive
Disorder (MDD), is characterized as a syndrome with a constellation of clinical manifestations.
These symptoms comprise a persistent depressed mood, hypersomnia (excessive daytime
sleepiness or prolonged nocturnal sleep), profound fatigue, and notable weight gain (amounting
to at least 5% of body weight within a one-month period) (Lyness, 2022). Notably, according to
an algorithm outlined in UpToDate.com, unipolar major depression emerges as a plausible
etiological candidate to account for the patient’s prevailing clinical presentation. This diagnosis
is particularly compelling, given the patient’s protracted history of depression spanning over a
duration of more than two years (Lyness, 2022).
2. Hypothyroidism: according to Ross (2022), the clinical manifestations of hypothyroidism are
highly variable, depending upon the age at onset and the duration and severity of thyroid
hormone deficiency. Common symptoms include fatigue, cold intolerance, weight gain,
constipation, dry skin, myalgia, and menstrual irregularities (Ross, 2022). Physical exam
findings may include goiter, bradycardia, diastolic hypertension, and delayed deep tendon
reflexes (Ross, 2022).
3. Polycystic Ovary Syndrome (PCOS): PCOS is a complex endocrine disorder that can
contribute to fatigue, depression, and weight gain through hormonal imbalances affecting mood
and energy levels (Barbieri & Ehrmann, 2022). Many women with PCOS have insulin resistance
which can promote weight gain and fatigue. The relationship between PCOS and the patient’s
symptoms can be complex and multifactorial. Diagnosis is dependent on Rotterdam criteria and
confirmed only when other conditions that mimic PCOS are excluded (Barbieri & Ehrmann,
2022).
Diagnostics
When patients exhibit depressive symptoms without concurrent general medical symptoms or
observable physical abnormalities, there is insufficient evidence to support the routine use of
laboratory screening tests (Lyness, 2022). However, in this scenario, it is important to have a
comprehensive blood count, serum chemistry panel, urinalysis, TSH, HCG (pregnancy), and
urine toxicology to rule out other causes for fatigue, weight gain, and hypersomnia (Lyness,
2022).
Treatment Plan for MDD
1. Counseling/Psychotherapy: this is a highly effective treatment for MDD. It provides a safe and supportive environment for individuals to express their thoughts and emotions through open and non-judgmental conversations with trained therapists. This can aid patients in identifying and understanding their thoughts and emotions which is the first step towards managing them (Lyness, 2022).
2. Antidepressant Medication: SSRIs are typical first-line agents used for major depression. However, an atypical agent like Bupropion is less likely to cause unwanted side effects for this patient like drowsiness and weight gain (Rush, 2022).
3. Lifestyle Modifications: exercise and physical activity help release endorphins which are natural chemicals in the brain that act as mood lifters. They promote feelings of happiness and play a crucial role in mood regulation. Regular exercise can improve the quality of sleep which overall leads to mood improvement.
4. PHQ-9: this depression screening tool can be implemented to assess for severity of depressive symptoms prior to and during treatment.
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