Recognizing and treating the patient with somatic manifestations of depression.

Depressed patients often present to their family physicians with physical complaints that mimic other medical diseases rather than the classic symptoms of sadness, hopelessness, or loss of pleasure in usual activities. These somatic presentations of depression can include gastrointestinal disturbances, complaints of chronic pain, fatigue, and/or an extensive history of unexplained medical illness. Depression and other psychiatric disorders occurring in the somatic patient can often be identified through the use of a routine and noninvasive questionnaire administered at the initial physician encounter. Regardless of its presentation, however, major depression should be treated vigorously, with full therapeutic doses of antidepressants administered for at least 6 weeks to determine response, and followed by at least 6 months to ensure full remission utilizing antidepressants whose side-effect profile may help ameliorate the patient's somatic complaints while avoiding those that might exacerbate them. Effectively diagnosing and treating the somatic patient's depression will improve his or her quality of life and may reduce their current excessive use of healthcare resources.