Key features of depression and its management in general practice.
 
 
"..Everything is ok in that department.."
 
Ali is a 45-year-old courier driver who presents with a three-week history of fatigue and a request for a tonic 'to pep him up a bit'. On questioning Ali says he feels depressed, although he can suggest no reason for this. There are no other features of depression, and no other symptoms of note.

Although Ali is a patient of your practice he very rarely comes to see you. He is married with two teenaged children. When you ask him about home life he looks a little embarrassed and says "everything is ok in that department". You know him as being reserved, and that he is typically reluctant to talk about his personal life. He says work is fine too, and that he has no other problems he can identify.

Ali has had no serious illnesses in the past, is taking no medications and drinks 4 glasses of beer per week. He is a non-smoker. You take this opportunity to check his blood pressure, which is normal. Physical examination is also normal. You request a full blood count and biochemical profile, give him advise about diet, exercise and regular sleep, and arrange to see him in a week to discuss things further.


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