Reading Body Language in MDD: A Story That Changed Practice

In "Reading Body Language in MDD: A Story That Changed Practice," Erin Crown, MHS, PA-C, CAQ-Psychiatry recounts the visit that convinced her screening tools alone are never enough.

Erin Crown explains why her practice largely returned to in-person visits after scaling back telehealth in 2021, reserving virtual care mainly for stable patients. Seeing a patient from head to toe, she says, lets her notice when words and body language don't match, something a screen can obscure. She illustrates this with a young woman she had treated for years who arrived for a routine visit appearing calm, making good eye contact, and reporting that everything was fine. But Erin Crown noticed her twiddling her thumbs and bouncing her foot rapidly, and the patient mentioned a reconciliation call with a brother Erin Crown had never heard about, despite asking every new patient about siblings at intake. Trusting those red flags, Erin Crown told the patient that what she heard and saw did not line up, and asked directly whether she was truly doing as well as she claimed. The patient admitted she had planned to attempt suicide that day. The call to her brother had been a reconciliation attempt before ending her own life. Erin Crown's team safely got her to the hospital.

Erin Crown uses the story to argue that screening tools are valuable but cannot replace relationship, eye contact, trust, and clinical instinct. She notes that anhedonia predicts relapse, and roughly 55 percent of patients with MDD who have it never see it resolved, which is why she asks about it proactively. The same applies to reduced libido and sexual dysfunction, which may reflect either the illness itself or a medication side effect. Drawing on her earlier career in urology, where sexual health was routine conversation, Erin Crown says patients often suffer silently because they don't realize a symptom is treatable, and clinicians need to get comfortable asking probing questions rather than waiting to be told.

The next episode, "Switch or Stay? Knowing When a Partial Response Is Worth Building On," features Dr. Citrome laying out his own framework for deciding whether to switch medications or stay the course.