Enigmatic patient Behind the depression hid another disease

Depression is often noticeable in a depressed mood, which is accompanied by impulses to drive, pleasure and joylessness as well as constant fatigue. Even for a mid-fifties, who was impotent and apathetic, doctors initially went from a depression. When it turned out that medication did not help and even more problems came along, the doctors investigated more closely.
Report about an enigmatic patient
Around one in four people at some point in their lives suffers from a mental disorder such as depression. In addition to physical symptoms such as headache or loss of appetite, it is primarily mental health problems that may indicate the condition. Typical is a depressed mood that goes hand in hand with impulsiveness, joys and joys. In many cases, the disease is not detected or only very late. But sometimes doctors also suggest depression, although there is another cause for the condition. So in the case of a woman from France. In a recent article, "Spiegel Online" reports on the enigmatic patient.

Mysterious illness behind a supposed depression.Image: kite_rin - fotolia

Medicines for change of nature
Listless, tired, exhausted: The 54-year-old, who introduced herself to the psychiatrists at the University Hospital in Caen, France, spent her days almost apathetic. She blamed herself for failing to do anything at work, describing herself as irritable, sensitive and almost unable to make decisions or start activities. This has been going on for months, but earlier it was completely different. It is said that the woman had taken an antidepressant for five months because of this change in her being without the medication changing her condition. She therefore discontinued it.

Taking pills worsens the problem
When the patient was examined at the University Hospital in Caen, the doctors noticed nothing special apart from the described symptoms. No neurological or internal abnormalities, stable weight, examined laboratory values: everything normal. When the doctors suggested another treatment trial with the antidepressant duloxetine, the patient agreed and immediately started taking the pills. Even with this, the success remained and after a further change of the drug, the symptoms did not improve, but it was added new. In addition to lack of motivation, the woman also had concentration and attention problems. Even suicidal thoughts spoke out the woman. She retreated to her bed as often as possible and stayed awake for hours.

Mental abilities checked
As Spiegel Online reports, it was the husband who urged to continue to investigate. After telling the doctors of his wife's memory gaps, they checked the so-called mini-mental status of the woman. It is a test that examines various cognitive areas and is primarily used to diagnose dementia. Among other things, the intellectual abilities in writing, reading and arithmetic as well as language skills and memory are examined. On a scale starting from a value of 24 or less, the woman assumed only a starting mental degeneration of only 19.

Tumors pressed on the brain
As the doctors in the journal "BMJ Case Reports" reported, they then joined further tests. It turned out that the patient had memory gaps in the linguistic and visual area, could hardly count and could not plan and implement certain courses of action. These findings made it clear to doctors that isolated depression was not the right or at least not the only diagnosis. When they then induced a computed tomography of the head, it was found that in several places tumors pressed on the brain of the woman. It was assumed that these were so-called meningiomas, usually benign tumors of the meninges, which are slightly more common in women than in men.

Typical symptoms of depression
One of the larger tumors was located on the left side in the anterior region, the so-called frontal lobe, which controls, among other things, impulses, actions, drive and attention. This also explains why the woman was above all impulsive and listless and could no longer reasonably think. As Spiegel Online writes, the former problems are often associated with depression, while the latter is atypical. Symptoms vary depending on where a meningioma grows and presses on healthy neural tissue. Among other things, headaches or paralysis, vision or hearing problems and balance problems or memory loss may occur. However, apart from these neurological complaints, there may also be isolated psychiatric changes such as depression, hallucinations, fears or apathy. It has been reported that doctors often find it difficult to find a tumor as a cause in these patients.

Patient is well again after surgery
When the woman finally underwent surgery after diagnosis, the pathology confirmed that it was meningioma. The procedure, which was not without risks, went well and a month later, the patient's depressive symptoms had disappeared. Even two years later, the woman is fine, she no longer needs medication. In their review of this rather peculiar case, the authors ask whether physicians should not always take computed tomography (CT) or MRI scans of a patient's brain before they diagnose depression. In recent years, among other things, was also reported by a possible blood test for the diagnosis of depression, but as a rule in the diagnosis, the mental change in the foreground. According to the revised S3 guideline on depression, imaging techniques such as CT or MRI in Germany are not included. According to DGPPN (German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology) is in this country only causes an imaging, if the depression despite medication does not improve or other symptoms are added. (Ad)