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Depression is a common and disabling feature in neurological outpatients
The depressions are a heterogeneous group of conditions. This is particularly true when depressive symptoms are experienced in the setting of coarse brain disease. Here the clinical presentation, differential diagnosis, and aetiology offer unique challenges to the clinician. The development of broader, more patient centred outcome measures such as quality of life and “health gain” has also elevated the status of depression, particularly because depressive symptoms are now seen to be the primary contributors to morbidity in some neurological illnesses. Two recent studies showed how depressive symptoms accounted for much more of the variance in morbidity in Parkinson’s disease (40%) than did movement disorder (17%).1,2 Critics of these studies could rightly point out that before the advent of L-dopa, motor disorder was definitely the biggest contributor to morbidity in Parkinson’s disease, and that quality of life as a measure is more directly related to mood state …