A 20-year-old girl presented with hypersomnia, anhedonia, anorexia, weight loss, decline in academic functioning, reduced libido for past one year. Menstrual cycle regular. TSH normal. MSE revealed euthymic mood. No depressive ideas or psychotic features, or obsessions.No stressors. Blood routine revealed mild anemia elevated ESR.
Had seen multiple consultations with different Psychologists and general practitioners without any improvement in functioning. Considering the possibility of MDD started on fluoxetine and reviewed the status after one month (40mg), but no response is seen. Revisited history again because of unresponsiveness and atypical presentation which showed the history of myalgia, joint stiffness, dry mouth, redness and sandy irritation in eyes, sinusitis. The patient's ANA titre was positive, as well as anti-Ro/SS-A antibody tests. Diagnosis of the Sjogren's syndrome was…
