Clinical considerations of depression

Major depressive disorder (MDD), commonly referred to as depression, occurs at a high rate in the general population and is associated with significan t morbidity and impairment. Treatment of MDD leads to a synchronous reducti on in accompanying disability. The management of MDD is complicated by issues such as lack of recognition, complexity of presentation, reluctance to accept a diagnosis or treatment, treatment failure, and locus of care. Recognition and intervention are often lower in older patients despite posi tive screening tests. Factors that may contribute to this underrecognition are associated medical illnesses and complex presentations, which often coe xist in patients with MDD. Because this condition has high associated medic al costs, recognition and treatment by primary care physicians is imperativ e. Other hurdles in managing MDD are the stigma associated with the term de pression, reluctance of patients to accept the diagnosis, and the rigidity of the Diagnostic and Statistical Manual of Mental Disorders criteria for d iagnosing this condition. Treatment failure and length of treatment are bot h problematic issues that need to be researched. The locus of care may also take on importance for certain types of patients.