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Major Depressive Disorder 3

Major depressive disorder
behavioral science


Vignette: A 23-year-old woman comes to the psychiatrist as she has been feeling sad and demotivated for the past 2 months. She has lost interest in her usual hobbies and has difficulty concentrating. She also reports increased appetite and weight gain. She sleeps more than usual and feels fatigued. She denies any thoughts of suicide and has no history of manic episodes. Her personal and family history is non-contributory. Her physical examination and routine blood work are normal.

Which of the following is the most likely diagnosis?


A) Major Depressive Disorder

B) Dysthymia

C) Bipolar Disorder

D) Atypical Depression

E) Seasonal Affective Disorder


D) Atypical Depression


The patient's symptoms of depressive mood, reduced interest in daily activities, fatigue, difficulty concentrating, increased sleep, and increased appetite with weight gain are suggestive of depressive disorder. However, the presence of mood reactivity (i.e., mood brightens in response to positive events) and two or more of the following: significant weight gain or increased appetite, hypersomnia, leaden paralysis (heavy, leaden feelings in arms or legs), or a long-standing pattern of sensitivity to interpersonal rejection differentiate Atypical depression (Choice D) from major depressive disorder (Choice A). This is a common subtype of major depression and is named "atypical" because the symptom pattern is "atypical" or "not typical" of melancholic (more "classic" or "typical") depression, which includes symptoms like significant weight loss or decreased appetite, insomnia, or excessive guilt.

Dysthymia (Choice B) is a chronic, milder form of depression that lasts for at least 2 years. The patient does not meet the criteria for Bipolar disorder (Choice C) as she has no history of manic episodes. Seasonal Affective Disorder (Choice E) is characterized by depressive episodes that occur typically in fall or winter and completely remit in spring or summer.


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