Guidelines for diagnosis and treatment of depression in patients with medical illness

Many medically ill people report depressed mood. Differentiating a true depressive syndrome from the expectable mood change due to the presence of the medical illness is problematic. The author describes criteria potentially useful in making this diagnostic differentiation and reviews predictors of treatment response in primary depression, with the implication that use of these criteria is clinically appropriate until more data on secondary depression are available. It is often necessary to formulate treatment for medically ill depressed patients on the basis of empirical observations, that is, to use a treatment trial for diagnostic as well as therapeutic purposes. In such treatment circumstances, it is imperative to use unambiguous criteria to define a therapeutic response and to stop or change treatment if these criteria are not met.