Differential Diagnosis

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While depression is generally thought of as a primary psychiatric disorder, it is also commonly seen with a variety of neurological and medical illnesses (Starkstein and Robinson, 1993; Glassman and Shapiro, 1998; Meyers and Scheibel, 1990). Recognition of these comorbid conditions is critical since different treatment strategies may be necessary for optimal clinical response in different populations. In evaluating a newly depressed patient, drug-induced mood changes, comorbid general medical illnesses, and substance abuse should always be considered, particularly in patients whose symptoms are atypical or of uncharacteristic onset. A related problem is the recognition of depression in patients with certain neurological disorders such as dementia or Parkinson's disease, where the diagnosis of depression may be obscured by neurological findings such as inattention, memory loss, apathy, motor slowing, or bradyphrenia (Marin, 1990; Starkstein et al., 1990a). Similarly, the presence of these cognitive symptoms in the absence of a true mood disturbance must also be considered, to avoid delaying more appropriate diagnostic or treatment interventions.

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