Signs & Symptoms
Most clinicians recognize depression when they see it, or perhaps feel it. The welling up of tears in a patient’s eyes, sluggishness, demoralization, or a pessimistic attitude attract the experienced clinician’s attention to the possibility of an MDE. Any one symptom of an MDE, however, is not specific and may be present in diverse disorders (see “Differential Diagnosis”). Moreover, even the experienced clinician who suspects depression must withhold a reflexive impulse to diagnose and treat it. Not all depressive signs and symptoms are diagnostic of MDD.
Symptoms of anxiety (e.g., worry, nervousness, tension, panic attacks) often accompany depression. These can either be secondary to an MDE or represent a comorbid anxiety disorder. The presence of anxiety often confounds the diagnosis of MDD and encourages treatment with benzodiazepines or other minor tranquilizers rather than antidepressant medication. The clinician must be careful to do a thorough evaluation for MDD when symptoms of anxiety are present.
Other symptoms that are commonly associated with depression and whose presence should trigger concern about underlying, unreported, or masked depression include pain (the more types of pain the patient reports, the greater the likelihood of underlying depression), sexual complaints (problems with sexual functioning or desire), and substance abuse or dependence.