Patient should have been depressed or dysphoric most of the day, for ≥2 weeks, with difficulties in social interactions or at work, and ≥4 of the following problems:

Patients with a diagnosis of major depression can often present with physical symptoms.

Depressed patients have a two- to fourfold greater risk for a recurrent cardiovascular event.

The first-line treatment is a selective serotonin reuptake inhibitor (SSRI) such as escitalopram. If patients do not achieve remission, switch to another SSRI or another class of antidepressant. Augmenting the response with either buspirone or bupropion is also effective.

All antidepressant medications can increase the suicidal behavior and ideation in children, adolescents, and young adults ages 18 to 24 years.

The DSM criteria include finding a history of many physical complaints beginning before age 30 years that occur over a period of several years and result in treatment being sought or significant impairment in social, occupational, or other area of functioning. Symptoms cannot fully be explained by a known medical condition or effects of a substance.

Somatic symptom disorders respond better when the intervention is early, without reinforcement by the excessive ordering of tests and evaluations.

To establish a diagnosis of panic disorder, both 1 and 2 must be present: