WHAT DOES THE TERM “MASKED DEPRESSION” REFER TO, AND CAN IT BE TREATED WITH PROZAC?
Masked depression refers to depression that is hidden behind physical complaints for which no organic cause can be found. The physician’s tendency is usually to dismiss these patients as hypochondriacs or to label them as anxious and prescribe minor tranquilizers to calm them down or stimulants to pep them up and get them out of the office as quickly as possible. Masked depression (also known as depressive equivalent, latent depression, hidden depression, overlooked depression, or disguised depression) is potentially one of the most frustrating and therefore serious of mental disorders for the patient, since if not diagnosed correctly and treated properly, the patient is likely to “doctor hop” for years, trying the patience of one physician after another. As Freud himself noted, physical complaints can dominate the clinical picture and lead one to believe that the disorder is strictly physical rather than emotional. In these instances, a succession of M.D.s may never address the patient’s despair. In the worst case, the patient will give up and commit suicide.
Since the underlying illness is depression, Prozac, like other antidepressants, can often be used effectively, although little research has been done on Prozac’s effect on masked depression per se. Because the new antidepressants (of which Prozac, Zoloft, Paxil, and Effexor are examples) have fewer side effects, it is most likely that patients with masked depression will be responsive to these drugs as they have been to the older antidepressants. The critical issue is to make the correct diagnosis of depression, since it is hidden to the patient and often the doctor fails to detect it as well and attempts to treat it as a medical condition.
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