Masked depression

Masked depression (MD) was a proposed form of atypical depression[1] in which somatic symptoms or behavioural disturbances dominate the clinical picture and disguise the underlying affective disorder.[2] The concept is not currently supported by the mental health profession.[3]

Clinical manifestations

Somatic manifestations of MD are distinguished by an extreme diversity[4]: 110  and include headaches, back pain, abdominal pain etc. Pathological behaviour masking depression may take the form of compulsive gambling, compulsive work, changes in arousal or orgasmic function, decreased libido or, on the contrary, impulsive sexual behaviour, alcoholism, or drug addiction.

Dispute about the concept

MD has been variously described as "depression sine [without] depression",[5] "latent" depression,[6] "vegetative depression",[8] "hidden" or "masked" depression,[10] "larvate" or "somatisation depression",[11] "depressive equivalents" etc.[12] Most investigators, especially those in the German-speaking countries, assumed masked depression (German: die larvierte Depression[13]) to be endogenous depression.[14] The term was largely used in the 1970s and 1980s, but at the end of the 20th century there was a decline in interest in the study of masked depression. Today this diagnosis does not play a significant clinical or scientific role.[15]

Epidemiology

MD is supposed to be a common clinical phenomenon.[16] According to some authors, masked depression is as frequent as overt depression.[17] Although masked depression can be found at any age, it has been observed more commonly after mid-life.[17]

Making the diagnosis and the management of MD in clinical practice are complicated by the fact that he who has got MD is unaware of his mental illness. Patients with MD are reluctant to associate their physical symptoms with an affective disorder[18] and refuse mental health care. As a rule, these patients attribute their disturbances to physical illness, seek medical care for them, and report only somatic complaints to their physicians,[19] with the consequence that many of such depressions are not recognized or are misdiagnosed and mistreated[16] Estimates of depressed patients who are correctly identified and treated range from 5% to 60%.[20] Data show that about 10% of people who consult a physician for any reason, originally has affective disorders disguised by physical symptoms.[17][21]

Official diagnostic status

Current classifications: ICD-10 and DSM-5 [22] do not contain the term "masked depression".[1] Some Ukrainian psychiatrists claim that MD is to be qualified as "depression with somatic symptoms" in the ICD-10 (F 3x.01).[23] This means that those who struggle with masked depression often have more physical symptoms such as back pain, abdominal pain, headaches, and even pain during sexual activity or painful periods. For those with more clinical depression, while they still may have physical symptoms, their symptoms are usually more mental or emotional. This includes feelings of helplessness, extreme and/or persisting sadness, numbness, tiredness, drowsiness, exhaustion, and even suicidal thoughts or feelings.

Diagnostic criteria

Affective disorders in patients with MD can only be detected by means of a clinician-administered diagnostic interview.[4]: 408 [24]: 576 [25] Organic exclusion rules[25] and other criteria are used in making the diagnosis of MD.[26]: 185–188  Some physical symptoms of masked depression include general aches, pains including headache, backache, musculoskeletal aches, and other nonpainful symptoms such as changes in appetite and libido, lack of energy, sleep disturbance, dizziness, palpitations, dyspnea, and gastrointestinal tract disturbances.[27]

See also

References
  1. Anna Miodek; Paweł Szemraj; Józef Kocur; Anna Ryś (2007). "Depresja maskowana – historia i współczesność" [Masked Depression – History and Present Days] (PDF). Pol. Merk. Lek. (in Polish). MEDPRESS. XXIII (133): 78–80. ISSN 1426-9686. Retrieved 2013-01-04. The paper is accompanied with an abstract in English.
  2. Verster, G. C.; Gagiano, C. A. (August 1995). "Gemaskerde depressie" [Masked depression] (PDF). South African Medical Journal (in Afrikaans). Health and Medical Publishing Group. 85 (8): 759–762. ISSN 0256-9574. PMID 8553144. Revue : Anglais
  3. Treating Child and Adolescent Depression. Lippincott Williams & Wilkins. 2012. p. 5. ISBN 978-1451153033.
  4. (in Russian) Коркина М. В., Лакосина Н. Д., Личко А. Е. Психиатрия: Учебник. — М.: Медицина, 1995. — 608 с.; ил. — [Учеб. лит. для студентов мед. вузов] ISBN 5-225-00856-9
  5. e.g. K. Schneider, 1925
  6. e.g. Lange J., 1928
  7. Thormann, J.; Himmerich, H.; Steinberg, H. (December 2011). "The concept of "vegetative depression" (1949) by Rudolf Lemke". Pharmacopsychiatry. 21 (6): A110. doi:10.1055/s-0031-1292551.
  8. e.g. R. Lemke, 1949[7]
  9. López Ibor J.J. (March 1972). "Masked Depressions". Br. J. Psychiatry. 120 (556): 245–258. doi:10.1192/bjp.120.556.245. PMID 4504771. S2CID 210450112.
  10. e.g. Lopez Ibor J.J., 1972;[9] Kielholz J.J., 1983; Pichot P.; Hasson J., 1973
  11. e.g. Gayral L., 1972
  12. For more detail, see: Katon, W.; Kleinman, A.; Rosen, G. (Jan 1982). "Depression and somatization: a review. Part I.". Am. J. Med. 72 (1): 127–35. doi:10.1016/0002-9343(82)90599-x. PMID 7058818.
  13. Steffen Walter's entry at ProZ.com.
  14. (in Russian) Вертоградова О.П. К проблеме депрессий в общесоматической практике // Сб. Депрессии в амбулаторной и общесоматической практике (вопросы диагностики и терапии). М., 1984, с. 12–17.
  15. Encyclopedia of Clinical Neuropsychology > Masked Depression
  16. Fisch R. Z. (1987). "Masked depression: its interrelations with somatization, hypochondriasis and conversion". Int J Psychiatry Med. 17 (4): 367–79. doi:10.2190/cr7j-wu5n-hc5x-2jq5. PMID 3326856. S2CID 39199561.
  17. Alexopoulos, George S. (1990). "Clinical and Biological Findings in Late-Onset Depression". In Tasman, Allan; Goldfinger, Stephen M.; Kaufmann, Charles A. (eds.). American Psychiatric Press Review of Psychiatry. Vol. 9. American Psychiatric Press. p. 250. ISBN 9780880482486.
  18. "Physical Symptoms in Depression: Interview with Thomas W. Koenig, MD" (PDF). Advanced Studies in Medicine.
  19. Brody, D.S.; Thompson T.L. etc. (March 1995). "Recognizing and managing depression in primary care". Gen Hosp Psychiatry. 17 (2): 93–107. doi:10.1016/0163-8343(94)00093-s. PMID 7789790.
  20. Patricia A. Carney etc. (December 1999). "Recognizing and Managing Depression in Primary Care A Standardized Patient Study". The Journal of Family Practice. 48 (12).
  21. Schneider, Frank; Sandra Kratz etc. (February 26, 2004). "Insufficient depression treatment in outpatient settings". Ger Med Sci. 2: Doc01. PMC 2703210. PMID 19675684.
  22. "DSM-5 / PsychiatryOnline Renewal 2020-2021". Electronic Health Library of British Columbia. 2020-08-04. Retrieved 2021-03-20.
  23. (in Russian) Подкорытов В. С., Чайка Ю. Ю. Депрессии. Современная терапия Archived 2017-12-29 at the Wayback Machine. — Харьков: Торнадо, 2003. — С. 54. — ISBN 966-635-495-0
  24. (in Russian) Психиатрия: Учебник. / Коркина М. В., Лакосина Н. Д., Личко А. Е., Сергеев И. И. — 2-е изд., доп., перераб. — М.: МЕДпресс-информ, 2002. ISBN 5-901712-12-9
  25. (in Russian) Жариков Н. М., Тюльпин Ю. Г. Психиатрия: Учебник. — М.: Медицина, 2000. — С. 193. ISBN 5-225-04189-2
  26. (in Russian) Психиатрия. Национальное руководство / Под ред. Т.Б. Дмитриевой, В.Н. Краснова, Н.Г. Незнанова, В.Я. Семке, А.С. Тиганова. — М.: ГЭОТАР-Медиа, 2011. — 1000 с. — (Национальные руководства). — 3000 экз. — ISBN 978-5-9704-2030-0
  27. Tylee, André; Gandhi, Paul (2005). "The Importance of Somatic Symptoms in Depression in Primary Care". Primary Care Companion to the Journal of Clinical Psychiatry. 7 (4): 167–176. doi:10.4088/pcc.v07n0405. ISSN 1523-5998. PMC 1192435. PMID 16163400.
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