Depression has a 6-month prevalence of 5.8 percent and a lifetime prevalence of 17%. Three fourths of patients with depression improve with therapy. I. Diagnosis

A. Clinical evaluation should identify characteristics of depressed mood, loss of interest in usually pleasurable activities, and history of past depression. Insomnia, hallucinations, suicidal ideation and planning, or alcohol and drug abuse should be sought. Symptoms may also include guilt feelings, thoughts of worthlessness, energy changes/fatigue, concentration/attention impairment, and appetite/weight changes.

B. Family history may reveal depression, suicide, or drug or alcohol abuse.

C. Suicide risk. The risk of suicide is higher in depressed patients who are divorced or widowed, elderly, white, male or living alone, and in those with chronic medical illness or psychotic symptoms.

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