Differential Diagnosis

Many medical conditions may cause or mimic depression. Physical disorders that have been associated with depression include Addison's disease, acquired immunodeficiency syndrome (AIDS), coronary artery disease (especially in those with myocardial infarction), cancer, multiple sclerosis, Parkinson's disease, anemia, diabetes, acute infection, temporal arteritis, hypothyroidism, and especially dementias. It is imperative that the physician complete a neurologic evaluation to rule out an underlying disorder as the cause of the patient's depression. In addition, many medications may worsen depression, especially cardiovascular drugs, hormones, typical antipsy-chotic agents, anti-inflammatory agents, and anticonvulsants.

Anxiety disorders may be caused or exacerbated by medical conditions, medications taken for other psychiatric or medical disorders, and other substances with stimulant properties. For example, hyperthyroidism can mimic or exacerbate anxiety disorders, and therefore thyroid function should be carefully evaluated when patients present with anxiety symptoms. In addition, lifetime risk of thyroid dysfunction appears higher in patients with panic disorder or GAD (Simon et al., 2002). Physicians should also assess the patient's use of other medications, especially stimulants (whether prescribed or obtained from other sources), nicotine, illicit drugs, and caffeine.

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