The difficult depressed patient in perspective.

Depression is a serious, chronic, and debilitating illness warranting speedy and effective intervention by psychiatrists and other physicians who see patients with depressive symptoms, whether or not severe enough to meet diagnostic criteria. Effective treatments are available for depressive symptoms, including pharmacotherapy with tricyclic antidepressants, monoamine oxidase inhibiting agents, or newer medications; psychotherapy (including cognitive therapy, behavioral approaches, and interpersonal therapy); and electroconvulsive therapy. Studies have shown, however, that patients' depressive disorders or symptomatology is often not treated or patients receive such low levels of treatment that episodes are prolonged and tend to recur. The implications are that depression is inadequately recognized and treated. Many factors undoubtedly contribute to the underrecognition of illness and generally inadequate treatment received by many patients with depression. Nevertheless, greater awareness and more effective treatment of depressive symptoms are needed to decrease depression morbidity and mortality.