Intended for healthcare professionals

Rapid response to:

General Practice

Influence of symptoms of anxiety on treatment of depression in later life in primary care: questionnaire survey

BMJ 1999; 318 doi: (Published 27 February 1999) Cite this as: BMJ 1999;318:579

Rapid Response:

Loud and soft depression

Dear Sir,
I have heard at a number of psychiatric meetings that depression
presenting with agitation/anxiety was much more likely to be picked up. As
a GP, agitation has always spoken more loudly to me and indeed, often made
it harder to conduct the consultation because it becomes agitating to be
with the person, information is hard to evince, concentration is lost and
instructions have to be oft repeated.

Autonomic dysfunction and unbelievable levels of gitiation were indeed a
major experience for me when my depression hit. Low mood and loss of
energy were at one end of the spectrum, but the complete opposite was
just as likely, often coinciding with suicidal ideation and the desperate
drive towards putting oneself out of one's own misery, for relief of the
physical sympoms as much as anything else.

Clear messages are now there for primary care educators and the notion of
'loud' and 'soft' depression is one I shall consider further - both are
awful for the sufferer, but as you have pointed out, they have different
implications for the clinician in terms of recognition, acknowledgement
and diagnosis.

Dr. Chris Manning

Competing interests: No competing interests

01 March 1999
Chris Manning