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EV0363

Undiagnosed type 1 diabetes mimicking depressive symptoms in an adolescent: a case report

UNDIAGNOSED TYPE 1 DIABETES MIMICKING DEPRESSIVE SYMPTOMS IN AN ADOLESCENT: A CASE REPORT

In a patient presenting with depressive symptoms and showing a limited response to antidepressant treatment, underlying type 1 diabetes was only diagnosed after ketoacidosis developed; following insulin treatment, the psychiatric symptoms resolved completely without psychotropic medication.

The aim of this study is to highlight that diabetes mellitus may present with nonspecific neuropsychiatric symptoms and that metabolic causes should be considered in patients presenting with depressive symptoms. The study presents the case of an adolescent who initially presented with symptoms suggestive of depression and was subsequently diagnosed with a metabolic disorder. The patient was an 18-year-old male who reported a 6-month history of low energy, avolition, anhedonia, irritability, social withdrawal, declining academic performance, decreased appetite with weight loss, and insomnia. He reported neither feelings of sadness nor suicidal ideation, had no prior psychiatric history or relevant medical history, and reported no substance use other than occasional alcohol consumption. Escitalopram was initiated and increased to 20 mg/day; when the response remained minimal, treatment was switched to fluoxetine 20 mg/day. Persistent low energy, anhedonia, avolition, and social withdrawal raised suspicion of the prodromal phase of a psychotic disorder, prompting the addition of amisulpride, which was titrated to 100 mg/day. One year after symptom onset, the patient presented to the emergency department with a 4-day history of abdominal pain, fatigue, vomiting, and fever. Severe diabetic ketoacidosis was identified, with a blood glucose level of 811 mg/dL and a blood ketone level of 5.6 mmol/L, and type 1 diabetes was diagnosed. Insulin treatment was initiated, psychotropic medications were discontinued during hospitalization, and the patient remained asymptomatic without psychiatric treatment one year after the diabetes diagnosis. The authors note that mechanisms such as oxidative stress, inflammation, and hypothalamic–pituitary–adrenal (HPA) axis dysfunction have been proposed to explain the association between type 1 diabetes and depressive symptoms. They emphasize that investigating underlying medical conditions, particularly in adolescents without subjective depressed mood and with a limited response to conventional antidepressants, may prevent misdiagnosis and unnecessary psychiatric treatment.

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