Patients with MD are reluctant to associate their physical symptoms with an affective disorder and refuse mental health care. As a rule, these patients attribute their disturbances to physical illness, seek medical care for them, and report only somatic complaints to their physicians, with the consequence that many of such depressions are not recognized or are misdiagnosed and mistreated Estimates of depressed patients who are correctly identified and treated range from 5% to 60%. Data show that about 10% of people who consult a physician for any reason, originally has affective disorders disguised by physical symptoms. Official diagnostic status
Current classifications: ICD-10 and DSM-5  do not contain the term "masked depression". Some Ukrainian psychiatrists claim that MD is to be qualified as "depression with somatic symptoms" in the ICD-10 (F 3x.01). This means that those who struggle with masked depression often have more physical symptoms such as back pain, abdominal pain, headaches, and even pain during sexual activity or painful periods. For those with more clinical depression, while they still may have physical symptoms, their symptoms are usually more mental or emotional. This includes feelings of helplessness, extreme and/or persisting sadness, numbness, tiredness, drowsiness, exhaustion, and even suicidal thoughts or feelings. Diagnostic criteria
Affective disorders in patients with MD can only be detected by means of a clinician-administered diagnostic interview. : 408 : 576  Organic exclusion rules and other criteria are used in making the diagnosis of MD.
Finally an intramolecular attack from the hydroxyl group of C2 to the carboxylic acid group closes the ring and forms the lactone umbelliferone. Synthesis of methoxsalen
The biosynthetic route then continues with the activation of dimethylallyl pyrophosphate (DMAPP), produced via the mevalonate pathway, to form a carbo-cation via the cleavage of the diphosphates. Once activated, the enzyme umbelliferone 6-prenyltransferase catalyzes a C-alkylation between DMAPP and umbelliferone at the activated position ortho to the phenol, yielding demethylsuberosin. This is then followed by a hydroxylation catalyzed by the enzyme marmesin synthase to yield marmesin. Another hydroxylation is catalyzed by psoralen synthase to yield psoralen. A third hydroxylation by the enzyme psoralen 8-monooxygenase yields xanthotoxol which is followed by a methylation via the enzyme xanthotoxol O-methyltransferase and S-adenosyl methionine to yield methoxsalen. Risks and side effects
Patients with high blood pressure or a history of liver problems are at risk for inflammation and irreparable damage to both liver and skin. The eyes must be protected from UVA radiation. Side effects include nausea, headaches, dizziness, and in rare cases insomnia. Methoxsalen has also been classified as an IARC Group 1 carcinogen (known to cause cancer) but is only cancerous when combined with light - UVA radiation. Society and culture
Author John Howard Griffin (1920–1980) used the chemical to darken his skin in order to investigate racial segregation in the American South. He wrote the book Black Like Me (1961) about his experiences. References
External links
"Methoxsalen". Drug Information Portal. U.S. National Library of Medicine.