Depression in medical patients

doi:10.1136/bmj.325.7356.149

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Robert Peveler,
Alan Carson,
Gary Rodin

Depressive illness is usually treatable. It is common and results in marked disability, diminished survival, and increased healthcare costs. As a result, it is essential that all doctors have a basic understanding of its diagnosis and management. In patients with physical illness depression may

Be a coincidental association
Be a complication of physical illness
Cause or exacerbate somatic symptoms (such as fatigue, malaise, or pain).

Aretaeus of Cappadocia (circa 81–138 AD) is credited with the first clinical description of depression

Clinical features and classification

The term depression describes a spectrum of mood disturbance ranging from mild to severe and from transient to persistent. Depressive symptoms are continuously distributed in any population but are judged to be of clinical significance when they interfere with normal activities and persist for at least two weeks, in which case a diagnosis of a depressive illness or disorder may be made. The diagnosis depends on the presence of two cardinal symptoms of persistent and pervasive low mood and loss of interest or pleasure in usual activities.

Criteria for major depression*

Five or more of the following symptoms during the same two week period representing a change from normal

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Adjustment disorders are milder or more short lived episodes of depression and are thought to result from stressful experiences.

Major depressive disorder refers to a syndrome that requires the presence of five or more symptoms of depression in the same two week period.

“Neurotic” symptoms, including depression, are continuously distributed in the UK population

The association between depression and mortality after myocardial infarction

Dysthymia covers persistent symptoms of depression that may not be severe enough to meet the criteria for major depression, in which depressed mood is present for two or more years. Such chronic forms of depression are associated with an increased risk of subsequent major depression, considerable social disability, and unhealthy lifestyle choices …