[From somatic symptoms to severe depression - the value of considering atypical presentation and ECT]

Functional symptoms can be very difficult to distinguish from atypical depression with leaden paralysis and increased fatigability but with adequate emotional reactions and relatively neutral mood. In cases with progressive and severe functional impairment, affective illness should be considered even when classic depressive symptoms are not apparent. ECT is an established treatment for severe depression and may be effective even when somatic symptoms dominate the clinical picture. This case illustrates the value of considering depression as a differential diagnosis in treatment-resistant functional conditions.