Neurotic Depression

Patient presents with symptoms consistent with a diagnosis of Neurotic Depression, also known as Dysthymic Disorder or Persistent Depressive Disorder.  The patient reports chronic low mood,  depressed affect, and feelings of sadness, hopelessness, and anhedonia for a duration exceeding two years.  Symptoms reported include  poor appetite or overeating, insomnia or hypersomnia, low energy levels, fatigue, difficulty concentrating, low self-esteem, and feelings of inadequacy.  The patient denies suicidal ideation or any history of manic episodes.  The patient's symptoms cause clinically significant distress and impairment in social, occupational, and other important areas of functioning. Differential diagnoses considered included Major Depressive Disorder, Adjustment Disorder with Depressed Mood, and medical conditions such as hypothyroidism.  A thorough review of systems and relevant laboratory tests were conducted to rule out organic causes.  Based on the patient's clinical presentation, history, and diagnostic criteria as per the DSM-5, the diagnosis of Neurotic Depression is established.  Treatment plan includes psychotherapy, specifically Cognitive Behavioral Therapy (CBT), to address negative thought patterns and develop coping mechanisms.  Pharmacological interventions may be considered, with selective serotonin reuptake inhibitors (SSRIs) as a first-line treatment option.  Patient education regarding the chronic nature of the disorder, medication management, and lifestyle modifications such as regular exercise and sleep hygiene will be provided.  Follow-up appointments are scheduled for ongoing symptom monitoring, medication management if applicable, and assessment of treatment efficacy.  Prognosis is generally favorable with appropriate treatment and adherence to the therapeutic plan.  Medical coding will utilize ICD-10 code F34.1 Persistent Depressive Disorder.