Woman’s multiple sclerosis initially treated as major depression

Monica lives in the frightening space between medicine, psychiatry and society.

For the past 12 years, she has known that her mood “disorder” would be a source of stigmatization and would invoke confusion and fear in her coworkers, subordinates, family and friends. What she didn’t expect was for these same prejudices to enter her medical care.

In her 40s, Monica (not her real name) had the American Dream — she was a successful wife, mother and vice president of a software company. Then she started having bouts of unprovoked crying that quickly led to social isolation.

While she didn’t necessarily feel terribly sad, she would burst out into tears. Her co-workers shunned her and her crying soon turned into true sadness and depression.

Eventually she was diagnosed with major depression and was even hospitalized twice for medication management, as well as electroconvulsive (“shock”) therapy. She found it difficult to process paperwork and she could no longer fulfill her job duties. Over the course of a few years, Monica’s life had spiraled downward to the point where she needed continuous psychiatric care.

Her excellent psychiatrist suspected an underlying neurological condition that could explain her depression and thinking problems. He sent Monica to a neurologist for further evaluation, including an MRI of the brain. While neurologists and psychiatrists both specialize in the human brain, psychiatrists focus on the synapses (the space between nerves), while neurologists focus on the wiring and infrastructure of the brain and the rest of the nervous system.

Monica’s neurologist took a careful medical history and found that she also had difficulty walking, as well as bouts of forced curling of her toes. On neurological examination, she had some twisting of her neck (called cervical dystonia) and some slight weakness in her face. She had brain MRIs that showed the white spots seen in patients with multiple sclerosis (MS). Monica’s symptoms were finally being explained by more than simply “bad depression.”

But was she ever really depressed?

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