Depression. (Women's Health Adviser).

Asking a few simple questions about mood and life enjoyment during a routine exam can pinpoint women who might be suffering from depression and set the stage for further evaluation and treatment.

Questions like "What have you enjoyed doing lately?" "How does the future look to you?" and "How has your mood been lately?" are probably as effective as formal screening tools in identifying depressed patients, and are much easier to use in an ob.gyn setting. The U.S. Preventive Services Task Force recommends that all primary care providers screen patients for depression.

Because depression is much more common in women, ob.gyns. are more likely than other primary care providers to encounter depressed patients. The illness strikes 1 in 4 women, but only 1 in 10 men. Despite its prevalence, up to 50% of depression goes unrecognized, contributing to the continuing high level of morbidity associated with the condition.

Diagnosis. Several factors play a role in the onset of depression. Serotonin and norepinephrine deficiencies can cause some symptoms. Last year, depression was linked to genetic factors as well. And environmental dynamics, like exposure to violence, neglect, abuse, or poverty, can also play a part.

Depression most often occurs in patients aged 24-44. years. The basic screening questions address depression's main diagnostic indicators: at least 2 weeks of persistent feelings of sadness or anxiety, or loss of interest or pleasure in usual activities. Additional symptoms include:

* Changes in appetite that result in weight loss or gain not related to diet. Insomnia or oversleeping.

* Loss of energy or increased fatigue. Restlessness or irritability.