Page 108 - JCBP-3-3

Journal of Clinical and
Basic Psychosomatics Comorbid MDD and FMS

symptoms at some point in their lives. The relationship headache, and migratory stabbing or burning pain in
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between FMS and MDD is complex and bidirectional. multiple body regions. Concurrently, she experienced
Although the chronic pain associated with FMS can cognitive decline, memory loss, and insomnia. The patient
precipitate depressive symptoms, preexisting depression reported feeling depressed, disinterested, and useless
may increase the vulnerability of patients to FMS. to her family. An extensive workup at another hospital,
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Moreover, these conditions share common neurobiological including imaging studies and laboratory tests (Table 1),
pathways, including dysregulation of the hypothalamic– revealed no significant abnormalities. Two months before
pituitary–adrenal (HPA) axis and alterations in the admission, her symptoms worsened following exhaustion
neurotransmitter systems. 5 from home renovations. She experienced intensified pain

Diagnosing and managing comorbid FMS and (widespread and migratory pain described as stabbing or
MDD present significant challenges due to overlapping burning, affecting multiple body regions), chest tightness,
symptoms, such as fatigue, sleep disturbances, and cognitive palpitations, decreased appetite, and further sleep
impairment. The concurrence of these conditions can deterioration. She was diagnosed with depression at our
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exacerbate symptoms and lead to poorer outcomes if not hospital’s Medical Psychology department. Duloxetine
adequately addressed. Recently, there has been a growing (60 mg/day) and lorazepam (1 mg/night) were prescribed.
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recognition of the need for a multidisciplinary approach However, the patient reported no significant improvement
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to treat patients with FMS and MDD. This approach after 1 month of treatment.
typically encompasses a combination of pharmacological The patient’s medical history included hypertension
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interventions, psychotherapy, and lifestyle modifications. for 6 years, which was controlled with perindopril (4 mg/
Herein, we have presented the case of a patient exhibiting day). She was the second of four siblings and had one
symptoms of FMS and MDD, highlighting the diagnostic son and three grandchildren. Her husband and son were
challenges and the effectiveness of a comprehensive frequently away for work, leaving her alone with her
multidisciplinary treatment approach. Although the granddaughter for extended periods in their rural home.
comorbidity between FMS and MDD is well-documented, On admission, her vital signs were within the normal
with up to 70% of FMS patients experiencing depressive range. The neurological examination was unremarkable
symptoms, studies regarding the optimal diagnostic except for hyperalgesia in multiple body regions. The
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approaches and treatment strategies for the concurrent psychiatric examination revealed a worried affect, poor
conditions are lacking. This case report demonstrates concentration, depressed mood, fatigue, decreased
the successful implementation of a comprehensive attention and memory, weight loss, feelings of helplessness,
multidisciplinary approach (pharmacological and non- and anxiety manifestations, including excessive health
pharmacological interventions), which often lacks detailed concerns and somatic discomfort. There were no psychotic
practical guidance. The report also provides insights
into the diagnostic process and treatment adjustments Table 1. Laboratory test results of our patient
required when managing the comorbid conditions while
addressing the challenges of overlapping symptoms that Test category Parameters Results Reference range
can complicate an accurate diagnosis. Finally, the report Complete blood Hemoglobin 13.2 11.5 – 15.5 g/dL
offers valuable data on long-term treatment outcomes, count White blood cells 6.8 4.0 – 10.0×10 /L
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which are often underreported. By describing our detailed Platelets 245 150 – 450×10 /L
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decision-making processes and treatment outcomes, we Liver function Alanine 28 7 – 40 U/L
aimed to enhance clinicians’ understanding of effective aminotransferase
management strategies for patients with comorbid FMS Aspartate 33 13 – 35 U/L
and MDD, particularly when initial treatment approaches aminotransferase
are insufficient.
Kidney function Creatinine 0.82 0.5 – 1.1 mg/dL
2. Case presentation Blood urea nitrogen 15 7 – 20 mg/dL
Electrolytes Sodium 140 135 – 145 mmol/L
A 63-year-old married female farmer presented to the
Neurology department in 2022 with a 3-year history of Potassium 4.0 3.5 – 5.0 mmol/L
generalized pain, fatigue, poor sleep, and depressed mood, Thyroid function Thyroid-stimulating 2.5 0.4 – 4.0 mIU/L
which had been exacerbated during the preceding 2 months. hormone
The symptoms originated following a fall during farm Free T4 1.2 0.8 – 1.8 ng/dL
work and were not associated with loss of consciousness. Inflammatory C-reactive protein 3.0 <5.0 mg/L
She gradually developed widespread numbness, dizziness, markers

Volume 3 Issue 3 (2025) 102 doi: 10.36922/jcbp.5069