The first form is depression presenting with somatic symptoms (10). Many patients with this condition may be resistant to accepting that they are depressed. They benefit from special additional measures that explain how emotional arousal and depression can cause their somatic symptoms. Such measures have been developed for many years, and have recently been elaborated (11). The second form is depression with panic attacks. While treatment of depression is the first priority in these patients, it is also important to give them advice on what to do during a panic attack, as it may take a little time before improvement in their depression stops further attacks. They need advice about not immediately leaving the environment in which the panic attack is taking place, explanations about catastrophizing thoughts and advice on helpful “self-talk”. They need to remind themselves that they have had such attacks before, and they will pass off if they calm down and remember the reassuring thoughts that run counter to the content of their thoughts during an attack. Such advice makes the attacks easier to deal with, and less likely to become still worse.

The third form is depression in people with obsessional traits. People with these traits in their usual personality often develop quite severe obsessional behaviour and depressive ruminations during a depression. These symptoms may be experienced as the leading symptoms, but can be thought of as epiphenomena of their depressive illness. It is helpful to take the patient through thought-stopping techniques, distraction techniques and response prevention. The fourth form is depression accompanying known physical illnesses. These depressions are particularly poorly recognized by generalists, who typically confine themselves to the treatments for the physical illness (12). Diagnosis of these depressions is complicated by the fact that four of the “diagnostic features” of depression (fatigue, poor sleep, poor appetite and weight loss) may well be caused by the physical illness. This may generate confusion, since no clear threshold for the number of symptoms needed for a diagnosis seems to exist if such symptoms are to be discounted. However, if there is a positive reply to either of the usual two screening questions for depression, it is only necessary to ask three additional questions dealing with poor concentration, ideas of worthless and thoughts of death. A total of three or more from this list of five symptoms allows depression to be diagnosed with high sensitivity and specificity, when assessed against the full list of criteria (13, 14). Successful treatment of the depression is associated with a low-