Q:

Does depression begin as depression or as something else? If it begins as some other process, how might this impact treatment strategy?

A:

Most patients with depression have some other life stressor, physical condition, or some other psychiatric condition which precedes and often contributes to the depression. Depression is rarely seen without the presence of some other comorbid condition or conditions which may be full syndromal, sub syndromal, or not readily apparent.   Effective treatment, therefore, should be directed to both the depression and the other conditions which contribute to the development of depression and interact with it to magnify the pathological process. It is, therefore, advisable to select an antidepressant agent with other therapeutic properties that may be effective in treating other interactive comorbid conditions. Remember the words of Sir William Osler:

"The young physician uses ten drugs to treat one condition,
while the older physician uses one drug to treat ten conditions."

We, therefore, need to consider both the breadth of treatment (the comorbid interactive disease states), as well as the depth of treatment (the effectiveness in treating depression).

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