Differential Diagnosis

The patient presents with a complex history of depression and symptoms that may be indicative of Attention Deficit Hyperactivity Disorder (ADHD). The following differential diagnosis is organized into categories to guide further evaluation and treatment.

• Single Most Likely Diagnosis
  • Major Depressive Disorder (MDD) with ADHD-like symptoms: The patient has a long-standing history of depression, with symptoms such as low mood, poor appetite, feelings of hopelessness, and low energy. The symptoms of inattention, disorganization, and procrastination could be part of the depressive syndrome or indicative of a comorbid ADHD.
• Other Likely Diagnoses
  • Attention Deficit Hyperactivity Disorder (ADHD): The patient's symptoms of inattention, disorganization, and difficulty with task completion are consistent with ADHD. The fact that these symptoms are affecting her academic and employment performance and contributing to her depression suggests that ADHD could be a comorbid condition.
  • Anxiety Disorder: The patient reports feeling anxious, particularly when faced with deadlines or tasks, which could indicate an anxiety disorder such as Generalized Anxiety Disorder (GAD).
• Do Not Miss Diagnoses
  • Bipolar Disorder: Although the patient does not report manic or hypomanic episodes, the presence of significant depressive symptoms and potential ADHD symptoms warrants consideration of bipolar disorder, particularly if there is a family history or if the patient has experienced mood swings or irritability.
  • Suicidal Ideation: The patient reports feeling that she would be "better off dead" but denies suicidal intent. However, any expression of suicidal thoughts or feelings warrants careful evaluation and monitoring.
  • Substance Use Disorder: The patient's history of depression and potential ADHD symptoms could be complicated by substance use, which might exacerbate or contribute to her symptoms.
• Rare Diagnoses
  • Borderline Personality Disorder: While less likely, the patient's long-standing history of depression, feelings of hopelessness, and potential impulsivity (e.g., procrastination) could suggest borderline personality disorder, although this would require further evaluation of interpersonal relationships, emotional dysregulation, and impulsivity.
  • Neurodevelopmental Disorders: Other neurodevelopmental disorders, such as autism spectrum disorder, could potentially present with symptoms of inattention and social difficulties, although these would be less common and require specific diagnostic criteria to be met.