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 categorized as follows:

• Single Most Likely Diagnosis
  • Major Depressive Disorder (MDD): The patient's symptoms of low mood, reduced interest/pleasure in activities, sleep difficulties, and feelings of guilt/self-blame over the relationship breakdown are key indicators of MDD. The recent relationship breakdown and ongoing stress also support this diagnosis.
• Other Likely Diagnoses
  • Anxiety Disorder: The patient's feelings of being overwhelmed, mind racing, and difficulty settling down to sleep suggest anxiety. The recent life stressors could contribute to the development of an 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, characterized by emotional or behavioral symptoms in response to an identifiable stressor.
  • Chronic Stress Reaction: The patient's symptoms of migraines, poor appetite, nausea, and low energy could be attributed to chronic stress, exacerbated by the relationship breakdown and possibly work-related stress.
• Do Not Miss Diagnoses
  • Thyroid Dysfunction: Although the patient's TFTs were normal, thyroid disorders can sometimes present with subtle symptoms and mood changes. It's crucial to ensure that thyroid function is thoroughly evaluated, especially given the patient's symptoms of low energy, mood changes, and sleep disturbances.
  • Sleep Disorder: The patient's sleep difficulties could be indicative of a primary sleep disorder, which needs to be addressed to improve overall mental health and well-being.
  • Nutritional Deficiency: Despite the patient's ferritin being within a relatively normal range, ensuring adequate nutrition, especially iron and vitamin B12, is essential, as deficiencies can contribute to mood changes, fatigue, and other symptoms presented.
• 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 rare 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 headaches could suggest CFS/ME, although this diagnosis requires a more comprehensive evaluation and exclusion of other causes of chronic fatigue.

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