Common Symptoms of Depression 10/15/00 ?

Q.What are the most common symptoms that can guide physicians in recognizing true depression?

A.The presentation of depression in family practice is somewhat different than that presenting in a psychiatric practice, mainly because the symptoms leading a patient to consult a primary care physician are of a physical nature. The symptoms may actually be a physical facade to rationalize the need to seek out and talk to a physician. In contrast, the patient consulting a psychiatrist de novo or as a referral has usually progressed further in the illness and may have developed an acceptance of the emotional component of depression. Typically, the symptoms presented as the main complaint to the primary care physician are fatigue and sleep disturbances. The fatigue is seldom related to exertion and can usually be recognized as being of a psychological nature. The sleep disturbances can be quite variable but the classical presentation is late-night or middle-of-the-night insomnia. A patient who awakens for no reason after a few hours of sleep should raise the physician's level of suspicion that a mood disorder such as depression may be involved. Once the initial presenting symptoms have been explored, it is essential to go on to a more detailed history and examination for other symptoms of mood disorder. The hallmark symptom of depression is anhedonia, or the inability to seek and enjoy pleasurable experiences. These experiences usually involve most aspects of daily living such as our basic appetites for food, sexual satisfaction, personal interaction, and the pleasure of accomplishing things such as with work. A second group of symptoms evolve from cognitive difficulties which lead to problems with concentration, and with appreciating and solving problems in a realistic manner. The appreciation of objective reality becomes distorted by a negative tone to all perceptions of the world, leading to a pessimistic and hopeless outlook for the future. A third group of symptoms evolves around a disturbance of regulatory hypothalamic mechanisms. These are identified through a diurnal variation in mood and activity level. The disturbances in the regulatory mechanisms affect the menstrual cycle and produce shifts in sleep patterns. In addition, a number of biological functions deteriorate, such as appetite, with its consequent weight loss. The DSM-IV lists the cardinal symptoms of depression and has by convention established the necessity of at least five of the cardinal symptoms being present for a duration of at least two weeks. It is important to maintain the proper perspective on these "checklists" for diagnosis; they are a guide to a confirmation of a clinical diagnosis and are not a diagnostic tool per se. They are really not meant to supersede a good clinical evaluation, but rather to assist in its confirmation DSM-IV DIAGNOSTIC CRITERIA FOR MAJOR DEPRESSION Five of nine symptoms present during the same two-week period: * Depressed mood most of the day, nearly every day * Diminished interest or pleasure in almost all activities * Significant weight gain or loss * Insomnia or hypersomnia nearly every day * Psychomotor agitation or retardation nearly every day * Fatigue or loss of energy nearly every day * Feelings of worthlessness or guilt * Diminished ability to think or concentrate, indecisiveness * Recurrent thoughts of death or suicide

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