Differential Diagnosis

The patient's symptoms suggest a complex psychiatric condition. The following differential diagnoses are considered:

• Single most likely diagnosis
  • Major Depressive Disorder (MDD): The patient's persistent low mood, difficulty getting up in the morning, concentration issues, sleep disturbances, diminished interest in previously enjoyable activities, and appetite changes are all consistent with MDD. The lack of response to antidepressants and the presence of anxiety symptoms, including panic attacks, also support this diagnosis.
• Other Likely diagnoses
  • Dysthymia: The patient's report of experiencing depressive symptoms since childhood, with no specific age of onset, could suggest a long-standing, low-grade depressive condition.
  • Anxiety Disorder: The patient's excessive worry, feelings of guilt, and occasional feelings of paranoia, as well as the recent development of panic attacks, suggest a co-occurring anxiety disorder.
  • Adjustment Disorder: The patient's report of stressors, including family dynamics and potential thyroid issues, could contribute to an adjustment disorder with mixed anxiety and depressed mood.
• Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
  • Bipolar Disorder: Although the patient denies feelings of increased energy or experiences suggestive of mania or hypomania, it is essential to consider bipolar disorder, as it can be deadly if missed and untreated.
  • Thyroid Disorder: The patient's potential thyroid issues could be contributing to their mood symptoms, and untreated thyroid disorders can have severe consequences.
  • Sleep Disorder: The patient's sleep disturbances could be a contributing factor to their depressive symptoms, and untreated sleep disorders can have significant consequences.
• Rare diagnoses
  • Schizoaffective Disorder: Although the patient denies psychotic symptoms, schizoaffective disorder is a rare condition that could be considered, especially if the patient's paranoia is severe or if there are other psychotic symptoms that have not been reported.
  • Neurodegenerative Disorder: In rare cases, depressive symptoms can be an early manifestation of a neurodegenerative disorder, such as frontotemporal dementia or Huntington's disease. However, this would be unlikely given the patient's age and lack of other symptoms.