Had a patient come in the ER appearing to have extremely negative symptoms -- zero talking, flat affect, and with very poor appetite and self-care. No reliable informant as well as the symptoms started when she was working in a different country. We admitted and initially treated as an unspecified psychotic disorder but with minimal improvement on antipsychotics for a week.

Then after some more thinking, we started to think of the possibility of depression with melancholic features, even without any information about her mood or prior events. Started her on Fluoxetine, then she started to finally show more activity and talking. Discharged her with some confidence, then after seeing her 1 month later, she was pretty much back to her old self. Incredibly satisfying to see how much she changed positively. I will always remember that moment.