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Updated: Feb 5, 2026

MRI-guided dmPFC-rTMS as a Treatment for Treatment-resistant Major Depressive Disorder
Published on: August 11, 2015
[Atypical presentation of depression leading to delay in treatment]
Arthur R Van Gool1, Maarten Meijer2, Tom K Birkenhäger3
1Yulius Geestelijke Gezondheid, Postbus 1001, 3300 BA, Dordrecht, Nederland. vangool@xs4all.nl.
Abstract:
Major depression can present with atypical symptomatology and as a consequence, delay can occur in passing through the relevant algorithm for biological treatment. The case of a 62-year old female is presented who eventually was diagnosed with a major depressive episode, with psychotic features. The atypical presentation led to persistent diagnostic uncertainty both during outpatient treatment in several mental health care institutions and during inpatient observation. As a consequence, proceeding to the next step of the algorithm for biological treatment for major depression was delayed. Factors involved in this diagnostic uncertainty are discussed.
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