Management of depression : guidelines

Abstract

Is the depression basically endogenous or mainly reactive? Many also suffer from coexisting anxiety which may overshadow the depression. One should exclude other psychiatric conditions such as obsessive compulsive disorder, schizophrenia or personality disorder. Endocrine disturbances and occult carcinomas are notorious for initially presenting with depression. Patients with psycho active substance abuse are often depressed. Although many patients complain of a miserable mood, others may only complain of apathy, loss of interest and enjoyment, reduced energy, which in turn causes tiredness, reduced activity and withdrawal. With some patients the main problems are reduced attention, concentration and consequent memory difficulties. Others have ideas of guilt, worthlessness and lowered self esteem. Several patients also complain of obsessive thoughts and behaviours.