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Make the Diagnosis: Depression

Prior Probability

Although most depression screening focuses on major depressive disorders, a number of treatable conditions may be detected by depression screening. In primary care, the combined prevalence of depression and dysthymia is approximately 7% to 12% (Table 19-7).

Table 19-7Prevalence of Depression and Dysthymia in Primary Care

Populations for Whom Depression Should Be Assessed

All adults.

Detecting the Likelihood of Major Depressive Disorder or Dysthymia

Table 19-8Likelihood Ratios for Detecting Major Depressive Disorder

Detecting the Likelihood of Major Depressive Disorder

Table 19-9Likelihood Ratios for Detecting Major Depressive Disorder or Dysthymia

Reference Standard Tests

A structured (eg, Diagnostic Interview Schedule) or semistructured diagnostic interview (eg, Structured Clinical Interview for DSM-IV) to establish diagnoses.

Original Article: Is This Patient Clinically Depressed?

Clinical Scenario

Mr P is a 52-year-old small-business owner with a 5-year history of controlled hypertension, for which he takes a thiazide diuretic. Otherwise, he is in good health. He presents for routine follow-up and notes a 1-month history of mild to moderate bitemporal headaches and feeling fatigued. The headaches occur about twice a week and are relieved by acetaminophen. He denies chest pain or dyspnea on exertion. He notes wryly that the “new economy” has left him feeling a bit “frazzled.”

You wonder whether the headache and fatigue are stress related, a somatic presentation of depression. What is the most effective ...

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