Presenting Complaints

• May present initially with one or more physical symptoms (fatigue, pain). Further inquiry will reveal depression or loss of interest.
• Sometimes presents as irritability.
• Some groups are at higher risk (e.g., those who have recently given birth or had a stroke, those with Parkinson's disease or multiple sclerosis.

Diagnostic Features

• Low or sad mood
• Loss of interest or pleasure
• Associated symptoms are frequently present:
  • Disturbed sleep, especially waking early feeling anxious or despair
  • Guilt or low self-worth or loss of self-confidence
  • Fatigue or loss of energy or decreased libido
  • Motor restlessness or slowing of movement
  • Poor concentration
  • Disturbed appetite
  • Suicidal thoughts or acts (always ask about suicide in a patient who admits to depression - are you at the end of your tether?, is life not worth living? have you thought about suicide? have you made plans?).
    
    
• Symptoms of anxiety, nervousness or panic are frequent presenting symptoms..

Differential Diagnosis

• If hallucinations (hearing voices, seeing visions) or delusions (strange or unusual beliefs) are present, see also section on Acute Psychotic Disorders about management of these problems. If possible, consider consultation about management.
• If history of manic episode (excitement, elevated mood, rapid speech) is present, see section on Bipolar Disorder.
• If heavy alcohol use is present, see sections on Alcohol Use Disorders or Drug Use Disorders.
• Some medications may produce symptoms of depression (e.g., beta-blockers, other antihypertensives, H2 blockers, oral contraceptives, corticosteroids).