Case histories for understanding depression in primary care

The chief complaint of depressed patients in a primary care setting is often not their dysphoric mood. Physical complaints are frequently the presenting symptom. Primary care physicians should include a depressive disorder in the differential diagnosis of patients complaining of multiple somatic symptoms, increase in alcohol or drug use, sleep and sexual dysfunction, or reports of anxiety. In the case of acute onset of depression, the physician should first rule out underlying medical illness or medication side effects as the etiology of the symptoms.