The role of depression in coronary artery disease.

The concept of depression encompasses a series of psychopathological disorders that differ in regard to symptomatology, severity, course and prognosis. It is important to individualize these disorders for a better understanding of the following studies and of their diagnostic management. Major depressive disorder, as defined by CID X 1 and DSM IV , may have different clinical characteristics (table I). A specifier that may be employed in diagnosing the major depressive episode is the presence of melancholic symptoms (melancholia), whose main characteristic is the loss of interest and pleasure in all or almost all activities and a lack of reactivity to usually pleasant stimuli. In these circumstances, the depressive mood does not improve, not even temporarily, when something positive happens. Yet, at least three of the following symptoms should be present for the diagnosis of major depression to be made: depressive mood qualitatively different from the normal, worsening in the morning, terminal insomnia (to wake up at least two hours before the usual time), psychomotor retardation or agitation, anorexia or significant weight loss (5% of the body weight per month), excessive or inappropriate guilt. Sometimes, however, the depressive disorder is atypical with mood reactivity, i.e., enhancement of the mood in response to real or potential positive events, significant weight gain, increase in appetite, hypersomnia, sensation of heaviness in the upper and lower limbs, in addition to a prolonged pattern of sensitivity to interpersonal rejection resulting in significant social or occupational impairment . The dysthymic disorder (dysthymia) is characterized by a chronically depressed mood lasting for most of the day, for the majority of days, and lasting for at least two years . The individual may note significant reduction in usual interests and in self-criticism, frequently seeing himself or herself as uninteresting and incapable. As these symptoms become part of daily life, usually they are not mentioned by the patient unless directly inquired about by André Luiz Langer Manica, Carolina Garcia Soares Leães, Benício Noronha Frey, Mário Francisco Juruena