Workup of a patient with depressed mood to rule out organic etiologies



  • In keeping with the broad differential diagnosis of mood disorder symptoms screening evaluations for general medical conditions and substance use syndromes that may mimic primary idiopathic mood disorders may be carried out.

  • History of present illness, past medical history, past psychiatric history, substance use history, current medications, family history, social history, developmental history, legal history, review of systems, and focused physical examination are indicated when evaluating patients with mood disorder symptoms.

  • Cognitive screening examinations, such as the MMSE or MOCA are also indicated in the routine evaluation of mood disorders, especially so in older patients and patients with a known or suspected cognitive disorder.

  • Routine screening tests in mood disorder diagnosis may include

    • CBC
    • S. Creat / BUN
    • S. Electrolytes - with calcium.
    • LFT
    • TSH
    • B12
    • Urine R/M
    • ESR, HIV, RPR
    • RBS or FBS if not recently done, follow up with HbA1C if required
    • ECG if clinically indicated
    • Urine pregancy test or HCG in a female of child bearing age - always ask for LMP atleast and document

  • Further tests indicated by history and physical examination may include

    • EEG
    • CT / MRI
    • ANA
    • 8AM Cortisol - follow up with DST [Cushings disease but also positve in depression] or ACTH stimulation test [Addission disease]
    • S. Prolactin
    • S. Free Testerone
    • S. Magnesium
    • Urine and blood screen for drugs and alcohol
    • ABG
    • 2d ECHO
    • USG Abdomen and Pelvis
    • KF Ring, Serum Ceruloplasmin
    • Urine test for porphobilinogen
    • D3 levels

  • Medical or neurological consultation is also warranted, whenever a general medical or neurologic condition is suspected.