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Despite the high prevalence of depressive symptoms and full major depressive episodes in patients of all ages, depression is underdiagnosed and undertreated by primary care and other nonpsychiatric practitioners, who are, paradoxically, the providers most likely to see these patients initially. Primary mood disorders include both depressive (unipolar) and manic-depressive (bipolar) conditions. Major depressive disorder (sometimes called unipolar depression) is characterized by one or more episodes of mild, moderate, or severe clinical depression without episodes of mania or hypomania (i.e., low-level mania).
Depression may co-occur with nonpsychiatric medical disorders or with other psychiatric disorders; it may also be brought on by the use of certain medications. Major risk factors for depression include a personal or family history of depressive disorder, prior suicide attempts, female gender, lack of social supports, stressful life events, and current substance abuse. The social stigma surrounding depression is substantial and often prevents the optimal use of current knowledge and treatments. The cost of the illness in pain, suffering, disability, and death is high. Given the strong evidence that treatments are effective, third-party coverage for the diagnosis and treatment of depression should be equal to that available for other medical disorders.
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