Diagnosis of depression in a general medical practice

Patients rarely admit that they are depressed, and the signs and symptoms may be subtle. We need not miss the diagnosis, however, if we listen carefully to the patient's compliants and trust our own clinical acumen. When should we refer depressed patients to a psychiatrist? When we do not have the time that the patient deserves and when the depression is severe. Of 76 patients with depression in my practice, I referred about 12% (9). Can we forget about general medicine once the diagnosis of depression is made? Emphatically not. Major physical disease was present in 75% (57) of my depressed patients, and virtually all had a potpourri of baffling physical symptoms that required careful diagnostic analysis.