Mood disorders are common among the medically ill and tend to worsen, as illness becomes more severe. Major depressive disorder (MDD) occurs in 4–6% of the general population, in 5–10% of medically ill outpatients, and in 10–30% of hospitalised medical inpatients.1-3 Rheumatic diseases such as fibromyalgia, chronic fatigue/pain syndromes, rheumatoid arthritis, systemic lupus erythematosus (SLE), scleroderma, and Sjögren's syndrome (SS) are associated with psychiatric disorders or symptom states. Depression is associated with increased functional disability, pain, and stressors like low autonomy, low income, marital status and high demands.4 ,5 By nature recurrent and progressive, it should be diagnosed and treated as soon as possible.

Patients with fibromyalgia and chronic fatigue/pain syndromes have premorbid and significantly higher rates of psychiatric disorders than do patients with rheumatoid arthritis, who were found to have similar rates of depression when compared with those with other chronic medical illnesses.6 ,7 In patients with rheumatological disease, SLE is the disease that poses many dilemmas to the treating physician. The diffuse, non-focal neuropsychiatric presentations of affective, behavioural, and cognitive symptoms in patients with SLE may be attributable to one or several neuropsychiatric disorders, occurring sequentially or simultaneously.8 No matter the origin of the mood disorder, treatment goals for depression include restoration of normal mood, prevention of suicide, return of self esteem, improvement in the quality of life and work productivity, and increase in satisfaction of both patients and doctors.

Diagnostic precision is required to provide timely and appropriate care. An accurate diagnosis of psychiatric disorders is made by the application of specific diagnostic criteria according to the fourth edition of the Diagnostic and statistical manual of mental disorders (DSM-IV) by assessing onset, duration, and course of depression.9 This is the gold standard of for diagnosing MDD. At least five of …