Making sense of the complex depressed patient

Part 1: medical illness, including effects of drugs and alcohol

Depression takes various forms in people with medical illness including normal experience, personality traits, adjustment reactions/disorders and clinical disorders. Differing approaches are required to treat these and enhance the patient’s ability to cope with the medical illness and other comorbidities.

Part 2: temperament and personality factors

Personality traits tend to be magnified in the presence of stress and depression – they ‘shape’ the presentation and add to the complexity of depressive episodes.

Part 3: melancholic and psychotic depression

Melancholic depression can occur in patients of any age but is more likely to have first onset in patients aged over 60 years. Patients with earlier onset melancholic depression are more at risk of developing bipolar disorder.