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PP-49 A Case of Recurrent Depression Associated With Undisclosed Kleptomania

PP-49 A Case of Recurrent Depression Associated With Undisclosed Kleptomania

Ezgi Şişman1, İlay Dalkıran2

1. Psychiatry Clinic, Kocaeli City Hospital, İzmit, Kocaeli, Türkiye
2. Department of Psychiatry, Faculty of Medicine, Kocaeli University, İzmit, Kocaeli, Türkiye

DOI: 10.5080/61upk.ozt529 Page 245
OBJECTIVE Kleptomania is an impulse-control disorder characterized by recurrent stealing accompanied by guilt or shame. In patients with recurrent major depressive disorder (MDD), unrecognized comorbid impulse-control symptoms may worsen functioning, complicate treatment response, and increase suicidal risk.We present a case of recurrent MDD with longstanding but undisclosed kleptomania contributing to depressive exacerbation and a suicide attempt, aiming to highlight diagnostic awareness.CASEA 39-year-old unemployed, married woman was admitted following a suicide attempt by ingesting solvent. She had a 13-year history of recurrent non psychotic major depressive episodes beginning postpartum, with five episodes lasting approximately six months each.At admission, she exhibited depressed mood, anhedonia, severe guilt, and marked functional impairment, including reduced self-care and parenting capacity. During a detailed interview, she disclosed longstanding kleptomanic behaviors for the first time; the intense guilt associated with these behaviors had precipitated the suicide attempt.The patient had previously been hospitalized for treatment-resistant MDD and received eight sessions of electroconvulsive therapy with partial response and early relapse.She reported partial benefit from venlafaxine 150 mg/day, accompanied by worsening kleptomanic urges.On admission, she was already receiving valproate, which was continued given its potential benefit on impulsive behaviors.Although bipolar-spectrum depression was not diagnosed, it had been considered externally;therefore, and in the context of severe suicidality and planned high-dose SSRI treatment, lithium(300 mg/day) was added for mood stabilization and suicide risk reduction. Fluoxetine(40 mg/day), quetiapine XR(300 mg/day), bupropion, and clonazepam were administered. By week 3, depressive symptoms and suicidal ideation markedly improved, while kleptomania-related guilt persisted at reduced intensity.Written informed consent was obtained. DISCUSSIONThis case underscores the clinical importance of systematically assessing concealed impulse-control symptoms in recurrent MDD.Continuation of valproate alongside lithium reflected a pragmatic strategy addressing impulsivity, suicide risk, and diagnostic uncertainty without reclassifying the primary diagnosis.Careful antidepressant selection and adjunctive psychotherapy may be crucial in managing residual guilt and relapserisk. Keywords: Recurrent depression, Kleptomania, Suicidal behavior