1. In any new presentation of depression it is important to first consider and exclude the following conditions, which may cause, predispose to, or exacerbate depression:
a. organic medical illnesses e.g. hypothyroidism, cardiovascular disease.
b. other psychiatric conditions e.g. anxiety and personality disorders
c. prescribed medications e.g. corticosteroids, NSAIDS
d. alcohol and substance use disorders.
e. psychosocial problems e.g. domestic violence

2. Subsyndromal' depressions are levels of depressive symptoms that do not meet Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for major depressive disorder or dysthymia.

3. Dysthymic disorder denotes a chronic low-grade depression, characterized by pervasive dysphoric mood for at least 2 years. Symptoms are less severe than those of major depression.

4. Dysthymic disorder is associated with an increased risk of major depression. When major depression is superimposed
on dysthymic disorder it is called "double depression".

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