SIGECAPS is the mnemonic we medical students memorize to learn the core symptoms of depression: sleep, interest, guilt, energy, concentration, appetite, psychomotor retardation, and suicidality. The practice questions we spend hours answering in preparation for Step 1 of the U.S. Medical Licensing Exam twist patient vignettes in tricky ways to fool us into misdiagnosing depression as insomnia in elderly women or attention deficit–hyperactivity disorder in inattentive adolescents. But despite their tricks, I would always nail those questions. The key was that if you looked hard enough, SIGECAPS was always hidden somewhere — an offhand mention of fatigue here, a seemingly unimportant reference to weight loss there. But despite my finely honed detective skills, I missed the diagnosis in a patient who was oversleeping alarms, couldn’t stop eating, had relentless fatigue, was always seeing the glass as half empty, and continually felt worthless. He even occasionally wished it would all end.
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