2. Depression and alcoholism. These are commonly associated, and it is important to determine which is primary and which is secondary. A depressive syndrome developing for the first time on a background of alcoholism is a common clinical occurrence. In a large series of alcoholic patients studied by Cadoret and Winokur, a secondary depression occurred in 30 of 61 females and in 41 of 112 males; moreover, once the alcoholism was established, depression became evident much earlier in the women than in the men. The opposite occurrence (i.e., the development of alcoholism on the background of a primary depression) is less common. Again, women are disproportionately affected. As mentioned earlier, these differences may be spurious; Winokur’s family studies (1991) suggest that the same genetic predisposition leads to depression in females and alcoholism and sociopathy in men. Whether there is a similar linkage between depression and drug addiction, for example to opiates, is not clear but it seems not, in our experience.
3. Depression in childhood and adolescence. We have observed depressive states in children and they have often been misdiagnosed by both pediatricians and psychiatrists. The common manifestations have been chronic headache, refusal to go to school, withdrawal from social activities, anorexia, vomiting and weight loss, and scholastic failure. Puberty is a time of onset in many cases and the disorder is frequent in late childhood and in high school and college students. It is a tragic mistake not to appreciate this fact and to treat the patient for some presumed nonaffective nervous symptoms, only to have the patient commit suicide.
4. Anxiety, hypochondriasis, and pseudodementia. These are clinical circumstances in which an underlying depressive illness may not be immediately apparent but must be suspected, as discussed in detail in Chap. 47. The complaint of severe chronic fatigue without medical explanation should raise the same suspicion (see Chap. 23). An elderly person with seemingly early signs of dementia may, on closer examination, turn out to have a severe depressive illness.
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