Unipolar depression and dysthymia

Depression is an under-recognized, undertreated, common relapsing disorder that causes significant distress and impairment in social and occupational functioning. It is associated with an increased risk of death, not only through suicide, but also from physical illnesses such as cardiovascular disease. High-risk groups such as those suffering from chronic physical health problems should be screened for depression. Its aetiology is multifactorial, and co-morbidity with other psychiatric disorders is common. The assessment of depression requires determining the duration, symptom severity, suicide risk and functional impairment of the current episode, co-morbid diagnoses, past mood and treatment history, as well as obtaining a developmental, social and family history. Treatment is guided by illness severity, presentation and previous history, and includes psychosocial interventions, with antidepressant medication reserved for persistent and moderate to severe depression. Prevention of relapse is a priority, and risk factors for this should be assessed and used to guide prophylactic drug and psychological treatment.