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Updated 28 September 2015

Answer: What's your diagnosis? – Case 29

Miss F, a 23-year-old preschool teacher, is feeling tired and drained. Based on her history, the most likely diagnosis is that she is suffering from depression.

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Miss F has a month's history of progressively worsening tiredness. Her symptoms started soon after she took up a new position at a local school. She is generally healthy. 

Diagnosing depression is no easy task. Generally patients complain about other things, and their doctor needs to pick up that there is more to the visit than meets the eye.

Read: Is this depression?

Depression usually causes a conglomerate of symptoms. These include:

1. Feeling tired for most part of the day

2. Not gaining any pleasure or satisfaction from activities that the person previously enjoyed doing

3. Emotional lability: feeling close to tears; sensitive and finding it difficult to control emotions

4. Excessive sleep or no sleep, or changes in sleeping behaviour

5. Changes in appetite: either no appetite or excessive eating

6. Poor concentration

7. Decrease in libido

8. Social isolation: preferring to be on one's own, not wanting to socialise with friends

Part of diagnosing depression is also to exclude other organic causes of symptoms, like thyroid disease. A full an thorough physical examination is therefore vital.

Examples of other questions to ask Miss F:

1. Are there any acute stressors that might be causing her symptoms?

2. Is there a family history of psychiatric disease?

3. Does she hear voices or see things that aren't real?

4. Does she ever experience episodes of excessive energy or "highs"?

5. Does she ever consider suicide or have thoughts of ending her life?

Other important sideroom investigations:

1. Pregnancy tests

2. Hemoglobin and sugar testing

What else to look out for on examination:

- Signs of thyroid disease

Important blood tests to do:

- Thyroid functions, kidney functions, iron levels

Treating depression is not always straightforward and may require both pharmacological intervention (e.g. anti-depressants) and psychotherapy (sessions with a clinical psychologist).

NOTE: Health24's on-site GP Dr Owen Wiese reveals new cases on Thursdays. The answer is posted with the story on Mondays, or you can get it in our Daily Tip – sign up here.

Previously on What's Your Diagnosis?

What's your diagnosis? -  Case 1: vomiting and weight loss

What's your diagnosis? -  Case 2: eye pain

What's your diagnosis? -  Case 3: strange behaviour and a bullet in the back

What's your diagnosis? -  Case 4: seeing odd things

What's your diagnosis? - Case 5: mysterious lungs

What's your diagnosis? - Case 6: runner with seizures

What's your diagnosis? - Case 7: swollen knee

What's your diagnosis? - Case 8: bloody semen

What's your diagnosis? - Case 9: confusing neurological signs

What's your diagnosis? - Case 10: diabetic teenager with unusual signs and symptoms

What's your diagnosis? - Case 11: bruising with no apparent reason

What's your diagnosis? - Case 12: severe tummy pain

What's your diagnosis? - Case 13: severe sore throat

What's your diagnosis? - Case 14: abdominal pain and swelling

What's your diagnosis? - Case 15: the world is spinning

What's your diagnosis? - Case 16: numbness in forearm

What's your diagnosis? - Case 17: burning urine

What's your diagnosis? - Case 18: boy with persistent fever

What's your diagnosis? – Case 19: lady who can't lose weight

What's your diagnosis? – Case 20: chest pain next to breastbone

What's your diagnosis? – Case 21: burning sensation in vagina

What's your diagnosis? – Case 22: vomiting and headaches

What's your diagnosis? – Case 23: frequent urination

What's your diagnosis? – Case 24: painful and swollen leg

What's your diagnosis? – Case 25: swollen knee and fever

What's your diagnosis? – Case 26: swelling of face

What's your diagnosis? – Case 27: sudden severe leg pain

What's your diagnosis? – Case 28: painful ear

What's your diagnosis? – Case 29: tired and drained

 
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