Depression: the tip of the iceberg

A number of potential obstacles to objective diagnosis have been described, somatic presentations of 'masked depression' being only one of these. The morbidity associated with untreated depressive illness, availability of effective treatment resources, and gradually increasing community expectations, have all contributed to an increased responsibility on the medical practitioner for accurate diagnosis. It is evident that not only intellectual diagnostic acumen but an attitude of tolerance and acceptance of pathological emotional states is fundamental in facilitating self-disclosure leading to accurate diagnosis, and is a foundation for effective treatment. A model of depressive illness which includes biological, psychological and social aspects is appropriate, and can greatly augment mastery of these problems in practice.