Clinical psychiatry conference: Biological and family indicators in depression

This case illustrates the following points: In susceptible individuals, stress or bereavement may trigger a depressive syndrome requiring a somatic treatment. The phenomenology of the depressed state may include characteristics of personality disorders, and clinicians should exercise caution in assigning a diagnosis of a personality disorder while a patient is in an affective episode. Clinicians must consider the possibility of a misdiagnosis of patients with a diagnosis of borderline syndrome, who may respond well when treated for an affective disorder. In asigning a psychiatric diagnosis, it may be important to consider onset, premorbid personality, longitudinal course, family history, response to treatment, outcome, and laboratory markers in addition to clinical features. Laboratory markers may be useful in confirming a diagnosis of major depression, but treatment should not be withheld on the basis of negative laboratory tests. When biologic markers are available, they may provide a useful means of monitoring treatment response and alerting the physician to those at risk for early relapse.