Diagnose MDD based on the PHQ-9 score of 14 indicating moderate depression, and initiate SSRI pharmacotherapy to prevent symptom escalation.

Two weeks after a significant loss, grief symptoms overlap substantially with MDD criteria. Diagnosing MDD and starting medication without distinguishing grief from a mood disorder is premature. The PHQ-9 measures severity, not etiology.

Diagnose adjustment disorder with depressed mood, as the symptoms emerged in direct temporal response to an identifiable psychosocial stressor.

Adjustment disorder is possible but requires establishing that the symptoms exceed what would be expected for the stressor, which is difficult to determine at 2 weeks after a miscarriage. Premature diagnostic labeling should be avoided.

Refer for grief counseling and close the psychiatric assessment, since the symptoms are clearly explained by the recent pregnancy loss.

Dismissing the presentation without full assessment risks missing MDD if it is present. The overlap between grief and MDD requires clinical differentiation rather than assumption.

Differentiate acute grief from MDD by assessing for pervasive worthlessness, non-reactive mood, and persistent functional impairment before making diagnostic or treatment decisions.

The DSM-5 removed the bereavement exclusion, meaning MDD can be diagnosed during grief — but clinicians must still differentiate normal grief from MDD. At 2 weeks post-loss, the symptoms described (tearfulness, worthlessness, appetite loss, insomnia) can reflect either. Key differentiators: In grief, sadness comes in waves and is tied to the loss. In MDD, mood is persistently low and pervasive. The PHQ-9 is severity-measuring, not diagnostic. Follow-up assessment over the coming weeks helps clarify the trajectory. Monitoring with supportive follow-up may be more appropriate than immediate pharmacotherapy at this stage.