June 1990

Depressed or Just Sick?-Reply

Author Affiliations

Durham, NC

Arch Intern Med. 1990;150(6):1349-1350. doi:10.1001/archinte.1990.00390180147035

In Reply. —Dr Jenkins has touched on an important and challenging problem that both researchers and clinicians face in diagnosing serious depression in medical inpatients. Are symptoms of depression due to organic illness and thus likely to respond to treatment of the underlying physical illness, or, on the other hand, are they of psychological origin and thus require counseling or antidepressant therapy? This difficulty, in part, arises from a lack of distinction between depressive symptoms and depressive disorder. Fleeting depressive symptoms (such as decreased energy, difficulty sleeping) are quite common among acutely ill medical patients (in or outside of the Veterans Administration system); however, such symptoms are often different in intensity and duration from those that comprise a major depressive disorder. The latter (by DSM-III-R criteria) requires a depressed mood most of the day, nearly every day for 2 weeks or longer, and the simultaneous presence of a constellation of

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