Depression: the great imitator in family practice

Psychiatric problems, especially depression, are common in primary care and can usually be treated successfully by family physicians if the diagnosis is made. Unfortunately, there is as yet no simple, definitive test for detecting depression. Family physicians must be aware that depression is very often masked by somatic or anxiety complaints. A pattern of increased office visits, with a constellation of varied functional somatic complaints, perhaps accompanied by disturbances in social relationships, often indicates the presence of a developing depression. Although hospitalization or psychiatric referral or both are in order for complex psychiatric diagnoses or for suicidal patients, the morbidity and the mortality of depression can be reduced by the alert family physician who provides both carefully managed antidepressant treatment and supportive therapy early in the course of the illness.