To the Editor.
—In his recent letter regarding the undertreatment of depression, Dr Berger1 identifies the major problem that primary care physicians face when dealing with depressive illness—getting the patient to accept the diagnosis. He suggests that we need a new name for the illness that does not carry the pejorative connotations of the term depression.For the last 6 years, I have taken a novel approach to somatic presentations of depressive illness. When faced with complaints such as chronic headaches, fatigue, sleep disturbance, or the ubiquitous request for "something for my nerves," I ask about core limbic symptoms since depression affects all the limbic system structures and functions.2-4 These symptoms include poor quality of sleep, fatigue, irritability, exaggerated pain perception, difficulty concentrating, trouble with short-term memory, difficulty with appetite control, anhedonia, decreased sexual interest, excessive guilt, and suicidal thoughts (often initially expressed as an urge to run
Reynolds RD. More Names for Depression: Is a Rose a Rose?. JAMA. 1997;278(12):982. doi:10.1001/jama.1997.03550120042029