Depression is a common response to health problems and is an often "underdiagnosed" problem in the patient population. People may become depressed because of injury or illness; may be suffering from an earlier loss that is compounded by a new health problem; or they may seek health care for somatic complaints that are bodily manifestations of depression.

Clinical depression is differentiated from daily emotions or sentiments of sadness by its gravity and extent.

 Most people occasionally feel down or depressed, but these feelings are short-lived and do not result in impaired functioning.

Clinically depressed people usually have had signs of a depressed mood or a decreased interest in pleasurable activities for at least a 2-week period.

An evident impairment in occupational, social, and total daily functioning occurs in some people. Others function appropriately in their interactions with the outside world by exerting great effort and forcing themselves to mask their distress.

Sometimes, they are successful at concealing their depression for months or years and astonish family members and others when they finally succumb to the problem.

Many people experience clinical depression but seek treatment for somatic complaints. The leading somatic complaints of patients struggling with depression are backache, headache, fatigue, abdominal pain, anxiety, malaise, and reduced desire or problems with sexual functioning.

These sensations are frequently manifestations of depressions. The depression is undiagnosed about half of the time and masquerades as physical health problems.

People with depression also exhibit poor functioning and high rates of absenteeism from work and school.

Specific symptoms of clinical depression are:

1. Feelings of sadness
2. Fatigue
3. Feelings of worthlessness
4. Guilt
5. Difficulty concentrating or making decisions

Changes in appetite, sleep disturbance, weight gain or loss, and psychomotor retardation or disturbance are also common. Often, patients have recurrent thoughts about death or suicide, or have made suicide attempts.

A diagnosis of clinical depression is made when a person presents with at least five of nine diagnostic criteria for depression. One of the first two symptoms present most of the time.

1. Depressed mood
2. Loss of pleasure or interest
3. Weight gain or loss
4. Sleeping difficulties
5. Psychomotor agitation or retardation
6. Fatigue
7. Feeling worthless
8. Inability to concentrate
9. Thoughts of suicide or death

Unfortunately, only one of three depressed people is properly diagnosed and appropriately treated.

In the United States, about 15% of severely depressed people commit suicide, and two-thirds of patients who have committed suicide had been sent by health care practitioners during the month before their death.

When patients make statements that are self-deprecating, convinced that things are hopeless and will not improve, and express feelings of failure, they may be at risk for suicide. Risk factors for suicide include the following:

1. Gender
    Women make more attempts. Men are more successful.

2. Family history of suicide
    Statistical reports show that nearly 80% of people who have committed
    suicide have family history of suicide.

3. Dysfunctional family
    Family members have experienced cumulative multiple losses and
    posses limited coping skills.

4. Substance abuse
    A person who abuses substances has an inability to make healthy
    decisions and to solve problems effectively.

5. Severe anxiety
    Research studies indicate a reduction in distress when anxiety and
    depression are treated with psycho-educational programs, the
    establishment of support systems, and counseling.

Explaining to patients that clinical depression is a medical illness and not a sign of personal weakness, and that effective treatment will allow them to feel better and stay emotionally healthy, is an important aspect of care.