Depression and comorbidity: A case report

Abstract

Introduction: The co-existence of depression and chronic disease is frequent. This association leads to a worse evolution, of both the psychiatric framework and the chronic disease. However, the depression diagnosis is not always evident and even when it is identified correctly it is often under-treated, either for reasons imputable to the doctor or due to the patients poor adhesion to the therapeutics. Description of the case: Maria frequently attends medical appointments complaining of dizziness, tinnitus, fatigue and bone and joint pains. The identified health problems include entities with a potential aetiological role in these symptoms, which are overvalued by the patient. However, the latter complied only irregularly with the pharmaceutical therapeutics and kept lifestyle detrimental to the control of such health problems. After multiple appointments of similar pattern she admitted, upon questioning, irritability, anhedonia, tendency for social isolation, hypersomnia and depressive humour, which she attributed to her physical aflictions. After several attempts to introduce anti-depressive medication, which the patient waived a few days later, alleging side effects, medical appointments at fortnight intervals resulted in a better compliance with the therapeutics, both anti-depressive and other, less complaints and better control of her chronic diseases. Comment: The emphasis on the somatic symptoms and the fact that they could be explained within the context of the patients co-morbidity, therefore withdrawn as criteria of depression suspicion, led to the masking of the latter over time. The doctor must always consider the frequency of depression associated with chronic diseases, in order to achieve better diagnosis acuity. The inclusive approach, accounting for symptoms that are irrespective of being explained by the coexisting pathology, lessens the risk of not diagnosing an oligosymptomatic depressive framework, notwithstanding the fact that it may generate false-positive features. On the contrary, the excluding approach used for some time retarded the (false-negative) diagnosis and the treatment, with repercussions on the control of the whole health problems and on the patients quality of life.