Differential Diagnosis

The patient presents with a complex array of symptoms including migraines, poor appetite, feeling overwhelmed, low mood, reduced interest in activities, and sleep difficulties, among others. Considering these symptoms, the differential diagnosis can be organized into the following categories:

• Single Most Likely Diagnosis
  • Major Depressive Disorder (MDD): The patient's symptoms of low mood, reduced interest/pleasure in activities, changes in appetite, sleep difficulties, fatigue, feelings of worthlessness (blaming self for relationship breakdown), and diminished ability to concentrate are all consistent with the diagnostic criteria for MDD. The recent relationship breakdown and ongoing stressors likely contribute to the development of depressive symptoms.
• Other Likely Diagnoses
  • Anxiety Disorder: The patient reports feeling overwhelmed, has sleep difficulties with a racing mind, and experiences anxiety symptoms that are not limited to her depressive symptoms. These could be indicative of an anxiety disorder, possibly generalized anxiety disorder.
  • Adjustment Disorder: Given the recent significant life event (7-year relationship breakdown), the patient's symptoms could also align with an adjustment disorder, where emotional or behavioral symptoms develop in response to an identifiable stressor.
  • Chronic Stress Reaction: The patient's symptoms of feeling overwhelmed, low energy, and sleep disturbances could be attributed to chronic stress, exacerbated by her recent relationship breakdown and possibly her work environment.
• Do Not Miss Diagnoses
  • Thyroid Dysfunction: Although the patient's TFTs were normal in June 2025, thyroid dysfunction can sometimes present with mood changes, fatigue, changes in appetite, and sleep disturbances. It's crucial to consider this, especially if symptoms persist or worsen.
  • Sleep Disorder: The patient's sleep difficulties could be indicative of a primary sleep disorder, which needs to be addressed as it can significantly impact mood and overall well-being.
  • Nutritional Deficiencies: Despite the patient's ferritin being within a relatively normal range and other blood tests being normal, ensuring adequate nutrition is essential, especially considering her poor appetite and history of iron deficiency anemia.
• Rare Diagnoses
  • Celiac Disease: Although the celiac screen was negative, and the patient does not have a known family history of celiac disease, it's a condition that can sometimes present with non-gastrointestinal symptoms, including mood changes and fatigue. However, given the negative screening, this is less likely.
  • Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME): The patient's symptoms of persistent fatigue, sleep disturbances, and brain fog could potentially align with CFS/ME, although this diagnosis would require further evaluation and ruling out of other causes.

Each of these diagnoses should be considered in the context of the patient's overall clinical presentation, and further evaluation or testing may be necessary to confirm the diagnosis and develop an appropriate treatment plan.