The 54-year-old patient was physically weaker, had stopped showing interest in her past hobbies and was spending more and more time in bed. She said she was feeling irritable, lacked willpower and blamed herself for not being effective at work. Her husband also mentioned problems with her memory.
After running lab tests on her and finding no abnormality, her doctors suspected the cause was psychological and prescribed different antidepressants, one after another, when they failed to work. But it turned out that the woman, who at that point had suffered from unexplained, untreatable depression for six months, had several tumors in her brain -- especially in the left frontal lobe, which is linked to more depressive symptoms than tumors in the back of the brain. After surgeons removed the growths, her depressive symptoms completely disappeared within a month. The discovery put a stop to her depression and prevented further brain damage, as well as saved her life.
Doctors usually only order brain imaging scans for patients who have neurological symptoms like seizures, vision and hearing loss or cognition problems, but this case is an important reminder that sometimes a psychiatric illness -- in this case, depression -- is the only outward sign of a brain tumor, the authors write in the journal BMJ Case Reports.
The woman turned out to have Meningiomatosis -- a condition in which several tumors, called meningiomas, are present in the brain. Meningiomas can be deadly, with a five-year survival rate of 70 percent. (To put that in perspective, this is worse than breast cancer's rate is 89 percent.)
To illustrate just how tricky it is to diagnose these benign, asymptomatic tumors, a 2004 study on meningiomas examined 72 cases and found that 21 percent of the patients first sought help because of psychiatric symptoms -- most of them related to depression or anxiety. We've also known for a long time that psychiatric illnesses like anorexia nervosa, depression, anxiety and schizophrenia can also be the only indicators that a mass is growing in the brain.
That said, it's important to note that depression and anxiety are far more common due to psychological factors.
"It seems unrealistic to prescribe brain imaging in every patient with a depressive syndrome,” the authors wrote in the study. "Indeed, depression is a frequent mental disorder, and brain tumours are remarkably rare in patients with depression.”
But based on this woman’s case, the authors did suggest a few ways to tell whether or not a person with depression should get scanned. If you're over 50, have never had depressive symptoms before and you're not responding to antidepressant medication, it may be time to consider a scan.
In this particular case, the woman had experienced several stressful events recently, but had no family or personal history of depression, and didn’t feel guilty or suicidal. In fact, it was this woman’s lack of feeling -- apathy to both good or bad news -- that the authors say is another sign that a brain scan was warranted.
Major depression is a condition caused by a complex mix of genetic, environmental, chemical and psychological factors. Most people can get treatment for their symptoms by taking antidepressant medication, going to psychotherapy sessions or doing both.
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