Monday, August 3, 2009
Is a medical illness causing your patient's depression?
Virginia K. Carroll, MD
Fifth-year resident, Departments of psychiatry and internal medicine, Rush University Medical Center, Chicago, IL
Jeffrey T. Rado, MD
Assistant Professor, Departments of psychiatry and internal medicine, Rush University Medical Center, Chicago, IL
A patient who comes to you for treatment of depression might also present with physical symptoms (such as, fatigue, nausea, balance problems, etc.) that could point to a medical illness. Endocrine, neurologic, infectious, and malignant processes and vitamin deficiencies could be causing your patient’s depression. To help differentiate various etiologies of depressive symptoms, we review common medical causes of depression, their distinguishing characteristics, and pertinent treatment issues.
DSM-IV-TR considers major depression secondary to a general medical condition to be diagnostically separate from a major depressive episode. When considering nonpsychiatric causes of depression, begin with a thorough medical history including current and past medications, illicit substance use, review of systems, and a detailed neurologic exam.
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