How I Treat: A Patient With Major Depressive Disorder With Anxious Features

W. Clay Jackson, MD, DipTh | University of Tennessee, Memphis Tennessee

Your patient is a 48-year-old Black woman who presented to your office 3 weeks ago with symptoms of fatigue, feeling down, crying, a lack of interest in pleasurable activities, and insomnia. The symptoms had been ongoing for about 2 months. She reported this was her second episode of similar symptoms. The first episode occurred after her second child was born, when she 32 years of age, and the episode resolved spontaneously over the course of several months. She did not report a history of any sustained time of feeling “better than normal” or having rapid speech or thoughts.

Her initial Patient Health Questionnaire score was 16, consistent with moderately severe depressive symptoms (item 9 was scored 0 for thoughts of suicide). Her Generalized Anxiety Disorder Screener (GAD) score was 9, consistent with mild symptoms of anxiety (she reported these symptoms coincided with the onset of her depressive symptoms). Her Rapid Mood Screener (RMS) was negative for bipolar disorder.

Her BMI was 33 kg/m2, and her affect was flat; otherwise, her physical examination was within normal limits. Her complete blood count, thyroid panel with thyroid stimulating hormone, and comprehensive metabolic panel were within normal limits, except for non-fasting blood glucose of 135.

You diagnose your patient with major depressive disorder (MDD) with anxious features.