When symptoms of disease overlap with symptoms of depression

The diagnosis of depression is often dependent on somatic symptoms which overlap with the symptoms of many medical illnesses.

We analysed tape recorded interviews of 46 out of 61 eligible community dwelling older adults with advanced disease and many somatic symptoms of depression. Participants answered an open question about feelings, and structured questions about symptoms of depression.

Twenty-four (39%) patients met DSM-IV symptom criteria for depression when somatic symptoms were included, and only 1 (2%) when they were excluded. Of the 24, 22 (92%) reported two or more psychological symptoms of depression and 14 of the 17 (82%) for whom transcripts were available disclosed feelings of psychological distress.

Although every older adult with advanced disease reported somatic symptoms of depression, most did not meet DSM-IV criteria of depression even when all somatic symptoms are included. Including somatic symptoms accurately identifies patients who warrant follow up when psychological distress in unstructured interviews is used as the gold standard. There is no need to exclude somatic symptoms when considering a diagnosis of major depression in medical patients.