She denies any history of drug or alcohol abuse, and a complete physical examination 3 months earlier showed her to be in good health

A 53-year-old female lawyer who has been married for 20 years comes to her physician’s office because she has not felt “up to par” over the past 2 months. She is married, has two grown sons, and has a good practice. In the past couple of weeks, she has stopped taking care of her appearance and has frequently called in sick to work, when she actually has been having difficulty getting out of bed. She states that she has lost her appetite recently and her interest in sex with her husband has decreased considerably. She recently told her husband that at times she wonders whether she should go on living. She denies any history of drug or alcohol abuse, and a complete physical examination 3 months earlier showed her to be in good health. Which of the following is the mostly likely diagnosis?

A. Bipolar I disorder
B. Generalized anxiety disorder
C. Major depressive disorder
D. Panic disorder
E. Schizophrenia

Explanation: The correct answer is C. This patient most likely has major depressive disorder. She has had symptoms for 2 months, surpassing the DSM-IV criteria for a minimal length of depression of 2 weeks. Her other symptoms include loss of appetite, hypersomnia, decreased libido, loss of energy and interest in pleasurable activities, and vague suicidal ideation, all of which are criteria for major depression. The diagnosis of bipolar I disorder (choice A), requires an episode of mania, with increased grandiosity, irritability, and impulsiveness, either currently or in the pastnone of which are seen in this case. Generalized anxiety disorder (choice B) requires frequent intermittent episodes of anxiety over a more prolonged period than 2 months. This diagnosis is ruled out in this patient by the absence of any prominent symptoms of anxiety. The diagnosis of panic disorder (choice D) requires discrete episodes known as panic attacks, with tachycardia, diaphoresis, and a sense of impending doom-none of which this patient describes. Schizophrenia (choice E) is ruled out because of the absence of psychotic symptoms, such as delusions, hallucinations, and disorganized thinking