Masked depression
Masked depression is a now mainly historical term, that was essentially a form of atypical depression in which somatic symptoms or behavioural disturbances dominate the clinical picture and disguise the underlying affective disorder. The term is no longer used in psychiatry in the United States or most other Western countries, where a more standardized somatic symptom disorder is preferred.
Clinical manifestations
Somatic manifestations of MD are distinguished by an extreme diversity and include headaches, back pain, abdominal pain etc. Pathological behaviour masking depression may take the form of compulsive gambling, compulsive work, changes in arousal or orgasmic function, decreased libido or, on the contrary, impulsive sexual behaviour, alcoholism, or drug addiction.Chronic pain is more often noted as a connection to MD by non-psychiatrists than psychiatrists, while lack of concentration is often noted by psychiatrists.
Dispute about the concept
MD has been variously described as "depression equivalent, a vegetative equivalent, a depression without a depression, and a hidden depression." Most investigators, especially those in the German-speaking countries, assumed masked depression to be a form of endogenous depression. The term was largely used in the 1970s and 1980s, but at the end of the 20th century there was a decline in interest in the study of masked depression. Today this diagnosis is rarely, if ever, used.Epidemiology
MD was thought to be a common clinical phenomenon. According to some authors, masked depression is as frequent as overt depression. Although masked depression can be found at any age, it has been observed more commonly after mid-life.Making the diagnosis and the management of MD in clinical practice are complicated by the fact that he who has got MD is unaware of his mental illness.
Patients with MD are reluctant to associate their physical symptoms with an affective disorder and refuse mental health care. As a rule, these patients attribute their disturbances to physical illness, seek medical care for them, and report only somatic complaints to their physicians, with the consequence that many of such depressions are not recognized or are misdiagnosed and mistreated Estimates of depressed patients who are correctly identified and treated range from 5% to 60%. Data show that about 10% of people who consult a physician for any reason, originally has affective disorders disguised by physical symptoms.