Major Depressive Disorder

(1). Major depressive disorder can easily be misdiagnosed as Bipolar disorder.  What is your take? 

(2). What other psychotropic medication could be used in managing a patient with severe major depressive disorder comorbid with anxiety?

(3). One crucial blood work to do when patients present with depressive symptoms is the TSH. What is the rationale?

Subjective:

CC (chief complaint): Patient States, “ I want to try medication since therapy did not help for my depressed mood and anxiety.  

HPI: BA is a 25-year-old Hispanic female who presents for initial psychiatric evaluation for symptoms of depression and anxiety. She reports she has been going for psychotherapy, which has not been effective for her depressed mood and anxiety, and was referred to the clinic by her therapist. The patient endorsed feeling depressed, sad, irritable, fatigued, insomnia, lost appetite, low energy, poor concentration, lack of motivation, helplessness, worthlessness, hopelessness, and guilt. She states, “I am not doing well and not where I should be. I feel guilty about many things in my childhood, including being physically and sexually abused and having a child in high school.” The patient states, I am a stepchild and feel I am always left out.” She reports that her symptoms started in 12th grade, but she did not realize what it was or seek help. However, symptoms have been worsening since January this year, affecting her relationship with her family, and she sought therapy. She reported suicidal ideation early this year with no plan or intention.

Ms. BA also reports excessive worries, muscle tension, restlessness, shortness of breath, trembling, and hot feelings. She reports that the anxiety symptoms became troubling two weeks ago, occurring almost daily, and have been increasingly worsening and impacting her functioning at work. The patient denies abdominal pain/discomfort or any tingling sensations. She reports no auditory or visual hallucinations, delusions, or episodes of high or low energy but reports shopping online for things that are not necessary. BA denies nightmares and flashbacks.