Version July 2025
ADHD: attention deficit hyperactivity disorder; MDD: major depressive disorder; PHQ-9: 9-item Patient Health Questionnaire.
* Common clinical scenarios that suggest the possibility of a depressive disorder include patients who present with depressed mood or dysphoria, a positive depression screen (ie, endorse depressed mood or loss of interest or pleasure in activities), or unexplained somatic symptoms.
¶ In primary care settings, many individuals with MDD present with predominant somatic symptoms; consequently, multiple unexplained somatic symptoms should prompt consideration of a depressive disorder. Examples of common somatic presentations of MDD include fatigue, headache, nonspecific musculoskeletal symptoms, abdominal pain, and dizziness. Clinicians should additionally evaluate symptoms for nonpsychiatric causes. Refer to related UpToDate content for details.
Δ Key clinical symptoms of depression appear in Inset. To assess for clinical symptoms of depression, clinicians can use validated self-report instruments (eg, PHQ-9) and/or direct questioning about symptoms.
◊ These patients are unlikely to have a depressive disorder. The patient's specific symptom constellation should direct additional evaluation. As an example, impaired memory or concentration might suggest dementia, delirium, anxiety, or ADHD, depending on the clinical context and accompanying symptoms.
§ Refer to UpToDate content on clinical features and diagnosis of bipolar disorder for details.
¥ These individuals require additional diagnostic evaluation to determine if they have MDD or another depressive disorder. Refer to UpToDate content on the diagnosis of depression in adults for details.