Approach

History

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.[1] 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.[45] 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).[46]

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