Posts Tagged ‘MDD’

What’s MDD?

March 1st, 2013

I chaired the APA workgroup that authored the third edition of the treatment guideline for major depressive disorder (MDD), published at the end of 2010. MDD is a typical DSM-3 (and beyond) diagnostic category—a behavioral syndrome, which doubtlessly encompasses many biologically distinct diseases. (Hence the varied responses of patients to our ministrations.) But even while we eagerly await the dawning of the era of personalized, genomically informed medicine in psychiatry, we can still assess each depressed patient with a careful differential diagnosis—considering substance abuse, medical and neurologic diseases, and personality disorders, among other possibilities.

This came to mind when a resident presented a case to me. The chief complaints were lack of energy and interest—certainly key components of MDD, but easily reflecting a host of other diagnoses. When I saw the middle-aged man, he had mask-like facies, bradykinetic features, and a resting tremor. On examination he displayed muscular rigidity. We referred the patient to a neurologist, who confirmed a diagnosis of Parkinson disease. The patient’s psychiatric complaints responded favorable to the antiparkinson regimen, as did his motor signs. We will soon taper his SSRI. It didn’t take long, and it sure helped this man.

-Alan J. Gelenberg, M.D.
Editor, Biological Therapies in Psychiatry
Shively/Tan Professor and Chair, Psychiatry, Penn State University
Editor-in-Chief, Journal of Clinical Psychiatry

Learn when to bend

August 30th, 2010

Earlier this week I interviewed a patient in front of our residents and medical students. A woman in her early 50s, she had been hospitalized following a serious suicide attempt.

The patient had borderline personality features, including cutting, that had begun in early adolescence. She also carried diagnoses of MDD eating disorder, and substance abuse.

What struck me on meeting her was how composed she was. She was calm and rational. She had it all together. She could see the path forward, understood the error of her ways, was intent on living healthy. It was an easy interview. I was terrified.

She was the last person to speak to her dad before he took his own life. She was 13. She retained considerable guilt about his death and had never completed grieving it. I feared she would follow his path.

In my own life, and observing friends, patients, and loved ones, I have come to value toughness, discipline, and resolve. But I have also learned to appreciate the roles that softness, flexibility, patience, acceptance, and humility must play in keeping us strong and resilient.  I told the patient that palm trees survive hurricanes by bending. I hope it helps.