Clinical depression in medically ill patients

Depression is common in this situation, but there are no agreed diagnostic criteria. Two main difficulties arise:

• distinguishing pathological mood disorder from appropriate sadness and adjustment

• determining the cause of somatic symptoms, such as anorexia, loss of energy, and sleep disturbance, which could be due to either mood disorder or the physical illness, or both.

If depressed mood is severe and/or prolonged more than a few weeks after the patient receives bad news about his or her condition, depressive illness (clinical depression) should be suspected. Detection of clinical depression is important because good relief of symptoms can often be achieved with antidepressant drugs.

Key symptoms suggesting clinical depression in the physically ill include guilt, perceiving the illness as a punishment, hopelessness, loss of interest, loss of pleasure (anhedonia), inability to feel warmth toward family and friends, or suicidal ideation. Depression sometimes presents with exacerbation of physical symptoms, such as difficult-to-control pain.

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