E d i t o r i a l

Dear Colleagues,

A sad mood is a typical symptom of depression. Its nature is determined by the features of the illness, and hence in itself it affects the various syndromes which shape the different types of depres- sive states.

These states are themselves characterized by phenomena which are either specific to the states or which, together, form a characteristic set of symptoms. These groups of symptoms help to distin- guish between different depressive states, with two kinds of results:

•Firstly, they allow an etiologic diagnosis to be established; this obviously has a significant impact on the treatment plan

•Secondly, following the course of these symptoms allows identification and quantification of the course of the disease.

The recognition of these distinctive elements, which can either complete the depressive pic- ture or even actually define it, is essential for patient management.

Thus, we can identify:

•Precipitating factors: psychoaffective, psychosocial, professional, somatic, nutritional, etc

•Environmental factors: background noise, seasonal changes, etc

•Comorbidity and associated conditions: endocrine or metabolic diseases, certain chronic somatic conditions, etc

•Intercurrent events: problems with dietary habits, pregnancy, the postpartum period, etc

•Drug interactions and iatrogenic effects: treatments with depressogenic effects ( -blockers for example), glucocorticoid treatment, etc

•Addictive disorders, eg,various drug addictions with central effects.

This is not an exhaustive list, but it provides an idea of the clinical complexity of the depres- sive state. It can be difficult to determine the primary cause of the pathology and thus to determine whether the depressive state should be considered secondary to one or several perceptible disorders, or whether it predates them and is simply aggravated by their presence.

In this issue we have addressed several areas of internal medicine and certain changes in phys- iology which can influence depressive states.

This was not an easy task, and we wholeheartedly thank the brilliant authors who have con- tributed, and of course in particular Dr David Rubinow, who, with the help of Drs Barry Lebowitz and Pierre Schulz, agreed to coordinate this issue.

Yours sincerely,

Jean-Paul Macher, MD