2013. Available at: . Date accessed: 12 Mar. 2013. Firstly, I thank Seifsafari, Firoozabadi, Ghanizadeh, and Salehi for their interesting and relevant study.1 In this they conclude that somatic symptoms have a central part in the presentation of depressed patients and they urge Inhibitors,research,lifescience,medical physicians

to not overlook the importance of such symptoms when synthesising their diagnosis and management plan. I agree it is incredibly easy for physicians who are not involved routinely with depressed patients to overlook some of the obvious presenting symptoms of depression both somatic and non-somatic (loss of interest in enjoyable activities, sleep change, etc.), and would imagine this is more likely to be the case in cultures where depression is on the ‘taboo spectrum’. The authors had an impressive sample of 500, all of whom were interviewed within one centre. Interviewing in one centre has pros and Inhibitors,research,lifescience,medical cons. Firstly, its likely to reduce operator variance as fewer doctors would have been involved in the assessment of these patients, but cons of a single institution importantly include protocol difference, which may exist between separate Inhibitors,research,lifescience,medical institutions and may have an effect on the

rate of correctly identified patients–that is to say, many junior doctors have strict protocols to work to, and their ability to elicit certain findings is to some extent dependent Inhibitors,research,lifescience,medical on these. With further respect to methodology, Seifsafari et al. aimed to use psychiatric interview as the variable for assimilations with various demographic factors. This seems to have

worked well to have given relevant and generalizable results. For my part, the most interesting finding of Seifsafari et al.1 is the lack of difference in suicidal ideation between Inhibitors,research,lifescience,medical males and females, which the authors have found. As the authors correctly describe, in the Western world major depressive episodes are believed to be more common in males. Other notable risk factors include drug and alcohol abuse, low intellectual quotient (IQ), first and lower social standing.2 To draw on this further, a recent study carried out by ourselves describes the importance of support for depressed substance users in the United Kingdom, due to their C646 concentration increased risk of suicidal ideation.3 We describe how a broader range of medical staff needs to be trained to have further skills to deal with this patient demographic, ‘widening the net’ for depression detection so to speak. In our study, we did not examine any sex differentiation and in light of the Seifsafari et al.1 study, this is perhaps something we should have done.