- This case shows that any medical condition may not be what it seems like on the surface.
Many things can lead to depression. Loss of a loved one, continued hardships, substance abuse, or physical imbalances in brain chemistry can all lead to a person losing all joy in life.
We can now add a new potential cause to the list.
A 15-year-old Taiwanese girl had been seeing doctors for a while because of sudden, severe depression. She was also engaging in self-harming behavior, seemingly involuntarily.
She had a history of epileptic seizures, so the doctors figured her past condition might be flaring up again. Yet, all scans and tests showed nothing of the short — although her brain was definitely firing out of sequence.
While scratching their heads and trying various treatments, the doctors noticed strange autoantibodies in her blood. Unlike antibodies, which attack foreign invaders in our bodies, autoantibodies attack the body itself.
It turned out that the girl had Sjogren’s syndrome (SS), a rare autoimmune disorder that generally causes dry eyes and mouth. In the girl’s case, though, the disease caused the autoantibodies to attack and inflame her brain cells.
Her own body was quite literally trying to shut down her brain.
Fortunately, there’s a happy ending to the story. With proper medication, the girl’s mood has improved and she can enjoy her life again.
Getting the Blues
The girl’s strange case was detailed in a recent report in the journal Frontiers in Immunology. According to the report, the story begins long before she began experiencing drops in her mood.
As a child, the girl has experienced bouts of epilepsy due to bacterial infection. That particular problem, however, got under control.
Fast-forward several years and a new issue cropped up. The now-teenage girl started having issues with her mood.
Her self-confidence plummeted and she became depressed and moody. She was also struggling to sleep, and would occasionally forget things.
At first, her loved ones probably thought she might’ve been experiencing typical teenage mood swings. Soon enough, though, her depression got so bad it was clear something was wrong.
Then, she experienced three seizures. Doctors, believing her epilepsy had resurfaced, put her on antiepileptic medication.
It didn’t work. Instead, she began experiencing “episodes” where she would become increasingly agitated. She also started involuntarily harming herself by scratching her skin and banging her head.
Obviously, all was not right, and back to the hospital she went.
The Rarest of Rare Diseases
The doctors gave the girl brain scans, which showed that her mood swings and self-harming behavior were linked to seizure-inducing electrical activity in the brain. However, there was no obvious reason why this was happening.
According to further brain scans and cerebrospinal fluid tests, there was nothing wrong with the girl. The doctors tested her for viruses, thyroid abnormalities, and even cancer — and they all came back negative.
Suspecting that the girl might have some form of brain inflammation, the doctors prescribed her anti-inflammatory medication. That worked briefly before her depression and self-harming episodes returned.
By now, the doctors were really puzzled. Then, they noticed something off during blood tests.
The girl’s blood was full of specific autoantibodies linked to Sjogren’s syndrome. That was strange because SS — a very rare disease affecting only 3% of adults worldwide — typically attacks fluid-producing glands in the eyes and mouth.
Sure, the girl was bothered by dryness in her eyes and tongue, but the brain issues didn’t match SS. Further tests, however, showed that this was indeed the case.
The girl had SS, but instead of her salivary glands, her autoantibodies were attacking brain tissue. Consequently, the girl’s brain was constantly inflamed, leading to her bizarre mood problems.
This time, the doctors prescribed the girl immuno-suppressants. Lo and behold, her mood improved drastically and her self-harming behavior stopped like magic.
Now, the girl has started to “bring her life back on track.”
Got to Dig a Little Deeper
The girl’s story ended well because her doctors were willing to consider underlying health issues for her depression. But what if they hadn’t?
There’s a very real risk that they could’ve treated her condition as purely psychiatric and tried to keep the girl on antidepressants and antipsychotics, although those medications had no effect on her. Who knows what could’ve happened to her if that had been the case.
“We emphasize the critical importance of physicians remaining vigilant regarding the possibility of underlying physical conditions when encountering sudden instances of self-harm behavior that appear to be out of context,” Dr. Chun-Hao Liu, a psychiatrist at the Chang Gung Memorial Hospital, told LiveScience.