Screening for MDD: Distinguishing Depression From Grief and Medical Mimics

"Screening for MDD: Distinguishing Depression From Grief and Medical Mimics" takes up the question of how the same illness looks different depending on who is doing the looking.

Dr. Alva asks Dr. Clayton how patients present differently in a primary care setting versus a psychiatric clinic. He wants to know which features separate major depression from transient sadness, grief, or a medical mimic such as thyroid dysfunction, B12 deficiency, sleep apnea, or malignancy. He also asks where guilt, worthlessness, and functional collapse sit in her weighting relative to sadness alone.

Dr. Clayton starts with a point she considers foundational for primary care. Women present roughly twice as often as men, and they are also more likely to go to their physicians in the first place. Sleep and wake changes come up, but fatigue is often the presenting complaint. Primary care may respond by checking a CBC or a thyroid panel, and those results do not get at the deeper issue. She notes that younger patients presenting in primary care can usually identify a triggering event. Once someone has had one or two episodes of major depression, however, the illness becomes independent of those triggers.

Dr. Clayton argues that anhedonia has been underdiscussed relative to its diagnostic weight. Patients who are not interested in anything, who have dropped their regular hobbies and are not living their lives, are showing functional impairment. That impairment is usually broad, because nothing can be sustained for long. People may push very hard at work and then have nothing left for home or social relationships. Primary care needs its own habit of listening for those concerns, while psychiatry does the fuller breakdown. On instruments, she uses the PHQ-9 consistently and administers the GAD-7. She calls the PHQ-2 completely inadequate and wants a baseline that is then followed for outcomes.

Up next, in "Untreated MDD: Brain Changes, Cognitive Burden, and Comorbid Anxiety," Dr. DeBattista makes the case for earlier treatment, and Dr. Shirikjian untangles the symptoms that depression and anxiety share.