Furthermore, elderly patients can suffer from subsyndromal depression, which does not fulfill the complete diagnostic criteria, even when antidepressant therapies are clearly needed.8 In those patients, sadness can be absent from the clinical presentation. Then, the question of the severity of depression is of particular clinical interest, to determine the potential selleck kinase inhibitor importance of sadness Inhibitors,research,lifescience,medical for a patient, as

well of the question of its identification. One of the main depression evaluation tools is the Hamilton Rating Scale for Depression (HAM-D9). Its various factorial analyses have consistently identified “depressed mood” and “reduced work and interest” to be the main symptoms of depression, which is consistent with international classifications. Scoring instructions have been published in agreement with its author,10 but not all versions have been approved by him. Other tools have also been constructed, such as the Beck Depression Inventory11 and the Montgomery and Asberg Depression Rating Inhibitors,research,lifescience,medical Scale (MADRS).12 To determine the clinical value of the various symptoms assessed by these scales, a hierarchical pattern of depressive symptoms has been identified with the use of the Present State Examination (PSE13), in a general population study. The authors concluded that Inhibitors,research,lifescience,medical the prevalence of the rarer symptoms such as guilty feelings, depression

worst in the morning, and suicide, were preceded by a higher prevalence of the most common symptoms, such as depressed mood, lack of energy, and worrying.14 Such

hierarchical patterns have also been described using the HAM-D15: for the HAM-D 6-item version, the frequency of depressive symptoms decreases in the following manner: depressed mood, tiredness Inhibitors,research,lifescience,medical and pain, psychic anxiety, guilt feelings, and psychomotor retardation. This hierarchical pattern, with a higher prevalence of depressed mood, confirms the clinical importance of sadness in the diagnosis Inhibitors,research,lifescience,medical of depression. Furthermore, using a neural network model on the results of the Epidemiological Catchment Area study (ECA), a more recent analysis16 revealed that sadness was among the symptoms Entinostat with the greatest impact on the occurrence of depression. Is sadness synonymous with depression? As Beck described it,1 sadness can be present in the general population, without any diagnosis of depression. Some epidemiological studies have reported the prevalence of depression in the general population, but only a few have detailed depressive symptoms. Among them, a relationship has been described between particular life events and depressive symptoms17 in the general population. Sadness was more frequently associated with deaths of loved ones and romantic fairly breakups to be at the origin of their dysphoric episode in patients reporting an adverse event, whereas subjects for whom no causality could be found reported a low mood less frequently. Another general population study, conducted in the UK,14 used the PSE to evaluate depressive symptoms.