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Year : 2020  |  Volume : 4  |  Issue : 2  |  Page : 240-241

Depression masquerading as gaming addiction in an Indian adolescent

Department of Psychiatry, T.N.M.C. and B.Y.L. Nair Ch Hospital, Mumbai, Maharashtra, India

Date of Submission30-Dec-2019
Date of Decision30-Jan-2020
Date of Acceptance07-Feb-2020
Date of Web Publication03-Nov-2020

Correspondence Address:
Dr. Hrishikesh Bipin Nachane
63, Sharmishtha, Tarangan, Thane West, Thane - 400 606, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/aip.aip_89_19

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How to cite this article:
Nachane HB. Depression masquerading as gaming addiction in an Indian adolescent. Ann Indian Psychiatry 2020;4:240-1

How to cite this URL:
Nachane HB. Depression masquerading as gaming addiction in an Indian adolescent. Ann Indian Psychiatry [serial online] 2020 [cited 2021 Apr 20];4:240-1. Available from: https://www.anip.co.in/text.asp?2020/4/2/240/299864


Recent years have seen an increase in the use of online gaming, particularly among adolescents. They present with gaming preoccupation, withdrawal, tolerance, loss of interest in other activities, socio-occupational impairment, other negative mood states, and failure to control gaming despite psychosocial problems.[1] Some researchers are dubious that digital games cause dysfunction, viewing the true culprit as pre-existing conditions such as depression or anxiety.[2] Often, depression in adolescents is “masked” or expressed in behavioral equivalents rather than directly observable affective symptoms, known as “depressive equivalents.”[3] It has been reported that depression and gaming addiction may coexist as comorbidities and as such require an approach that targets both the conditions simultaneously. We describe a case wherein an adolescent boy presented with depression masked by gaming addiction. Treatment modalities are suggested.

A 15-year-old boy presented with excessive online gaming. He reported playing the game for majority of the day and used to think about it whenever he was involved in any other activities. He took less interest in any other activity and avoided going out of the house. He started getting more irritable and his sleeping hours became more erratic as he found himself playing the game late in to the night. He used to be fatigued and exhausted upon waking up but still could not control the urge to play the game. On detailed assessment, what appeared initially as gaming addiction was subsequently diagnosed as depression. The pointers that went in favor of depression were the intermittent affective disturbances that were in excess, anhedonia, sleep and appetite disturbances and fatigue. The patient was treated with fluoxetine, which was started at 20 mg and gradually increased to 60 mg. Along with it, behavioral therapy in terms of activity charting was started for the patient, wherein he was asked to chart his gaming use and then gradually reduce the same over time. The patient was called for close follow-up and improved gradually. His gaming time was restricted to 2 h per day.

Many depressive syndromes are manifested initially in a masked fashion that belies their presence and the masking process varies.[4] While typically other substances have been shown to present as depressive equivalents, the author calls attention to gaming disorder/gaming addiction that may also mask or hide a depressive illness. Severity of affective disturbances, marked anhedonia, and fatigue pointed towards an affective disorder, rather than gaming disorder in the patient. It is prudent to identify such markers which point toward a more serious illness such as depression or anxiety. A combination of pharmacotherapy and behavioral therapy worked best in the patient. It is possible that even in such patients, a combined approach may be required. More research in this area is warranted. Hence, adolescents with gaming addiction must be screened for depression as their management and outcome vary.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Rehbein F, Kliem S, Baier D, Mößle T, Petry NM. Prevalence of Internet gaming disorder in German adolescents: Diagnostic contribution of the nine DSM-5 criteria in a state-wide representative sample. Addiction 2015;110:842-51.  Back to cited text no. 1
Kim NR, Hwang SS, Choi JS, Kim DJ, Demetrovics Z, Király O, et al. Characteristics and psychiatric symptoms of Internet gaming disorder among adults using self-reported DSM-5 criteria. Psychiatry Investig 2016;13:58-66.  Back to cited text no. 2
Lesse S. The multivariant masks of depression. Am J Psychiatry 1968;124(11S):35-40.  Back to cited text no. 3
Strober M, Green J, Carlson G. Phenomenology and subtypes of major depressive disorder in adolescence. J Affect Disord 1981;3:281-90.  Back to cited text no. 4


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