Abstract

Feeling unhappy about being ill seems so understandable – but it is easy to forget that the majority of people do not suffer from sustained low mood when they have a physical disease, even a chronic and disabling one (see Robertson and Katona 1997, for review). For those who do have a depressive disorder co-existent with physical illness, the result seems to be a lower quality of life, and worse outcomes from treatment (Creed et al. 2002). The recognition and treatment of co-existent depression ought therefore to be a part of the management of all chronic disease, and neurology is no exception.

Review articles, like chess games, have a limited number of conventional openings. The next move in developing the current argument would normally be to lament the hopelessness of most doctors when it comes to recognizing depression in their clinical practice, before going on to offer the Psychiatrists’ Gambit – routine