Masked depression

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Masked depression (MD) was a proposed form of atypical depression[1] in which somatic symptoms or behavioural disturbances dominate the clinical picture and disguise the underlying affective disorder.[2] The concept is not currently supported by the mental health profession.[3]

Clinical manifestations[edit]

Somatic manifestations of MD are distinguished by an extreme diversity[4]:110 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, drug addiction and more.

Dispute about the concept[edit]

MD has been variously described as "depression sine (without) depression" (K. Schneider, 1925), "latent" depression (Lange J., 1928), "vegetative depression" (R. Lemke, 1949[5]) "hidden" or "masked" depression (Lopez Ibor J.J. [es], 1972;[6] Kielholz J.J., 1983; Pichot P.; Hasson J., 1973), "larvate" or "somatisation depression" (Gayral L., 1972), "depressive equivalents" etc.[7] Most investigators, especially those in the German-speaking countries, assumed masked depression (German: die larvierte Depression[8]) to be endogenous depression.[9] 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 does not play a significant clinical or scientific role.[10]


MD is supposed to be a common clinical phenomenon.[11] According to some authors, masked depression is as frequent as overt depression.[12] Although masked depression can be found at any age, it has been observed more commonly after mid-life.[12]

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[13] 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,[14] with the consequence that many of such depressions are not recognized or are misdiagnosed and mistreated[11] Estimates of depressed patients who are correctly identified and treated range from 5% to 60%.[15] Recent data show that about 10% of people who consult a physician for any reason originally suffer from affective disorders disguised by physical symptoms.[12][16]

Official diagnostic status[edit]

Current classifications: ICD-10 and DSM-IV do not contain the term "masked depression".[1] Some Ukrainian psychiatrists claim that MD is to be qualified as "depression with somatic symptoms" (F 3x.01), according to ICD-10.[17]

Diagnostic criteria[edit]

Affective disorders in patients with MD can only be detected by means of a clinician-administered diagnostic interview.[4]:408[18]:576[19] Organic exclusion rules[19] and other criteria are used in making the diagnosis of MD.[20]:185–188

See also[edit]


  1. ^ a b Anna Miodek; Paweł Szemraj, Józef Kocur, Anna Ryś (2007). "Depresja maskowana – historia i współczesność" [Masked Depression – History and Present Days] (PDF). Pol. Merk. Lek. (in Polish). MEDPRESS. XXIII (133): 78–80. ISSN 1426-9686. Retrieved 2013-01-04  The paper is accompanied with an abstract in EnglishCS1 maint: Multiple names: authors list (link)
  2. ^ Verster, G. C.; Gagiano, C. A. (August 1995). "Gemaskerde depressie" [Masked depression] (PDF). South African Medical Journal (in Afrikaans). Health and Medical Publishing Group. 85 (8): 759–762. ISSN 0256-9574  Revue : Anglais
  3. ^ Treating Child and Adolescent Depression. Lippincott Williams & Wilkins. 2012. p. 5. ISBN 1451153031.
  4. ^ a b (in Russian) Коркина М. В., Лакосина Н. Д., Личко А. Е. Психиатрия: Учебник. — М.: Медицина, 1995. — 608 с.; ил. — [Учеб. лит. для студентов мед. вузов] ISBN 5-225-00856-9
  5. ^ Thormann, J.; Himmerich, H.; Steinberg, H. (December 2011). "The concept of "vegetative depression" (1949) by Rudolf Lemke". Pharmacopsychiatry. 21 (06): A110. doi:10.1055/s-0031-1292551.
  6. ^ López Ibor J.J. (March 1972). "Masked Depressions". Br. J. Psychiatry. 120 (556): 245–258. doi:10.1192/bjp.120.556.245.
  7. ^ For more detail, see: Katon, W.; Kleinman, A.; Rosen, G. (Jan 1982). "Depression and somatization: a review. Part I.". Am. J. Med. 72 (1): 127–35. doi:10.1016/0002-9343(82)90599-x.
  8. ^ Steffen Walter’s entry at
  9. ^ (in Russian) Вертоградова О.П. К проблеме депрессий в общесоматической практике // Сб. Депрессии в амбулаторной и общесоматической практике (вопросы диагностики и терапии). М., 1984, с. 12–17.
  10. ^ Encyclopedia of Clinical Neuropsychology > Masked Depression
  11. ^ a b Fisch R. Z. (1987). "Masked depression: its interrelations with somatization, hypochondriasis and conversion". Int J Psychiatry Med. 17 (4): 367–79. doi:10.2190/cr7j-wu5n-hc5x-2jq5. PMID 3326856.
  12. ^ a b c Alexopoulos, George S. (1990). "Clinical and Biological Findings in Late-Onset Depression". In Tasman, Allan; Goldfinger, Stephen M.; Kaufmann, Charles A. American Psychiatric Press Review of Psychiatry. 9. American Psychiatric Press. p. 250.
  13. ^ "Physical Symptoms in Depression: Interview with Thomas W. Koenig, MD" (PDF). Advanced Studies in Medicine.
  14. ^ Brody, D.S.; Thompson T.L. etc. (March 1995). "Recognizing and managing depression in primary care". Gen Hosp Psychiatry. 17 (2): 93–107. doi:10.1016/0163-8343(94)00093-s. PMID 7789790.
  15. ^ Patricia A. Carney etc. (December 1999). "Recognizing and Managing Depression in Primary Care A Standardized Patient Study". The Journal of Family Practice. 48 (12).
  16. ^ Schneider, Frank; Sandra Kratz etc. (February 26, 2004). "Insufficient depression treatment in outpatient settings". Ger Med Sci. 2: Doc01. PMC 2703210. PMID 19675684.
  17. ^ (in Russian) Подкорытов В. С., Чайка Ю. Ю. Депрессии. Современная терапия. — Харьков: Торнадо, 2003. — С. 54. — ISBN 966-635-495-0
  18. ^ (in Russian) Психиатрия: Учебник. / Коркина М. В., Лакосина Н. Д., Личко А. Е., Сергеев И. И. — 2-е изд., доп., перераб. — М.: МЕДпресс-информ, 2002. ISBN 5-901712-12-9
  19. ^ a b (in Russian) Жариков Н. М., Тюльпин Ю. Г. Психиатрия: Учебник. — М.: Медицина, 2000. — С. 193. ISBN 5-225-04189-2
  20. ^ (in Russian) Психиатрия. Национальное руководство / Под ред. Т.Б. Дмитриевой, В.Н. Краснова, Н.Г. Незнанова, В.Я. Семке, А.С. Тиганова. — М.: ГЭОТАР-Медиа, 2011. — 1000 с. — (Национальные руководства). — 3000 экз. — ISBN 978-5-9704-2030-0

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