A 28-year-old female presents for complaints of fatigue, increased sleeping, and weight gain. She states she has had depression off and on since she was 17. She denies any other health problems and has never taken any prescription medication, including anything for depression.
What are your differentials? What laboratory tests could you perform? How would be your treatment plan?
The differential diagnosis will be
Depression, hypothyroidism, Anemia, Pregnancy.
The most probable diagnosis is Depression. The rationale for the diagnosis is the patient presents with some depression symptoms. These include fatigue, increased sleeping, and weight gain. She also states she has had Depression off and on since she was 17. Depression can be episodic, thus recurring several times during an individual’s lifetime (Seifert et al., 2021).
The other likely diagnosis is Hypothyroidism. This is a common problem caused by the failure of the thyroid gland to produce enough of certain crucial hormones (Bekkering et al., 2019). The rationale for the diagnosis is the patient presents with some hypothyroidism symptoms. These include fatigue, weight gain, and increased sleeping. Besides, the patient’s gender and age put her at significant risk of Hypothyroidism. Women are about ten times more likely to get Hypothyroidism than men due to Hashimoto’s thyroiditis, the most common autoimmune condition in women.
The other likely diagnosis is Anemia. The condition is caused by low hemoglobin levels, impairing the adequate distribution of oxygen in the body. This results in fatigue and increased drowsiness. The current patient presents with some of these symptoms: fatigue and increased sleeping. Besides, the patient’s reproductive age puts her at significant risk of anemia due to menstruation (Benson et al., 2021).
Pregnancy is the other differential diagnosis. The patient presents with early pregnancy symptoms, such as fatigue, increased sleeping, and weight gain. The patient’s reproductive age also puts her at significant risk of pregnancy. However, it will be essential to gather more information regarding the patient’s sex and reproductive health (Dempsey, 2021).
A complete blood count will be conducted to assess for anemia and the presence of infections that may be causing the symptoms. The blood test will also entail assessing HCG levels in the blood to determine whether the patient is pregnant. A THS test and a thyroid hormone test will be ordered to test the thyroid to ensure its functioning correctly. A psychiatric evaluation and DSM-5 criteria for Depression will be administered to confirm the depression diagnosis.
The treatment plan will entail medications and psychotherapy (cognitive behavioral therapy). The patient was prescribed citalopram, a Selective serotonin reuptake inhibitor (SSRIs) to manage the symptoms, and psychotherapy to help cope with the illness. SSRIs are the recommended first-line treatment therapy for Depression (Seifert et al., 2021). They are considered safer because they cause fewer side effects than other types of antidepressants.
Bekkering, G. E., Agoritsas, T., Lytvyn, L., Heen, A. F., Feller, M., Moutzouri, E., … & Vermandere, M. (2019). Thyroid hormones treatment for subclinical hypothyroidism: a clinical practice guideline. Bmj, 365. https://doi.org/10.1136/bmj.l2006
Benson, C. S., Shah, A., Stanworth, S. J., Frise, C. J., Spiby, H., Lax, S. J., … & Klein, A. A. (2021). The effect of iron deficiency and anaemia on women’s health. Anaesthesia, 76, 84-95. https://doi.org/10.1111/anae.15405
Dempsey, A. C. (2021). Examination for Pregnancy: Biochemical Tests. Bovine Reproduction, 479-485. https://doi.org/10.1002/9781119602484.ch39
Seifert, J., Engel, R. R., Bernegger, X., Führmann, F., Bleich, S., Stübner, S., … & Grohmann, R. (2021). Time trends in pharmacological treatment of major depressive disorder: Results from the AMSP Pharmacovigilance Program from 2001–2017. Journal of Affective Disorders, 281, 547-556. https://doi.org/10.1016/j.jad.2020.12.073