The risk of major depression is considered to be dependent on the severity, frequency, persistence, and number of pain symptoms.47,48 From the perspective of primary care an epidemiological study assessing the predictive power of chronic pain for depressive morbidity

showed that the prevalence rate of at least one chronic painful physical condition Inhibitors,research,lifescience,medical (CPPC) in the general population was 17.1%. At least one depressive symptom was present in 16.5% of subjects; 27.6% of these Selleck Crenolanib subjects had at least one CPPC. Major depression was diagnosed in 4% of subjects, and 43.4% of these subjects had at least one CPPC, which was 4 times more often than in subjects without depressive disorder.49 This significant Inhibitors,research,lifescience,medical Interrelationship of CPPC and depression confirmed the earlier clinical advice of Katon, suggesting that if all patients with painful physical conditions were systematically assessed regarding a possible underlying depression, some 60% of all states

of depression could be detected in primary care.50 Generally, one has to keep in mind that, both from a cross-sectional and a longitudinal perspective, there is a relevant overlap of depressive, anxiety, and somatoform disorders, especially chronic painful physical conditions, among primary Inhibitors,research,lifescience,medical care patients presenting with medically unexplained symptoms.51-58 It is an important clinical finding that, with an increasing number of medically unexplained symptoms, the risk of an underlying depressive

disorder increases in an Inhibitors,research,lifescience,medical impressive dose-response relationship. In a study which included 1000 adults and another study comprising 500 patients with a chief complaint of somatic symptoms, the presence of any somatic symptom increased the likelihood of a mood or anxiety disorder by two- or threefold. Only 2% of patients with no or only one somatic symptom had a mood disorder, but 60% of those patients presented nine or more somatic symptoms.31,59 Patients with multiple medically unexplained somatic symptoms also show a greater amount Inhibitors,research,lifescience,medical of associated other psychiatric comorbidity.60,61 Somatic symptoms in depression and rates of diagnostic recognition within primary care The typical form of presenting a depression In primary care Is via somatization. This form of somatic presentation, however, Carnitine dehydrogenase is considered to be one of the main reasons for low rates of recognition of depression In this sector of the medical care system.20,62 It must be acknowledged that the alarmingly low figures of diagnosed and consecutively treated depressive disorders in only 25% to 33% of affected patients found in epidemiological studies during the early 1990s have increased up to some 60%. 17,19 From a perspective of primary care, general practitioners are consulted by two groups of depressed patients who may pose a diagnostic challenge.