Patients may present with a history of depressed, anxious, irritable, or flat mood, anhedonia, weight changes, libido changes, sleep disturbance, psychomotor problems, low energy, excessive guilt, poor concentration, or suicidal ideation. Patients often have a personal or family history of depression. Some, but certainly not all, will have experienced a recent stress, trauma, or loss, or have comorbid medical illness. In older patients, depression can present as diminished self-care, somatic complaints, psychomotor retardation, irritability, and apathy. These patients may also present with severe cognitive disturbance (memory deficits) as a result of the depression. Older patients may also be more likely to have single or multiple comorbidities that contribute to the development of depression (e.g., malaise from medical illness or side effects of non-psychiatric medications).
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