Objective:Patients with depression present with psychological and somatic symptoms, including general aches and pains. In primary care, somatic symptoms often dominate. A review of the literature was conducted to ascertain the importance of somatic symptoms in depression in primary care.Data sources and extraction: MEDLINE, EMBASE, and PsychLIT/PsychINFO databases ( -January 2004 were searched for the terms depression, depressive, depressed AND physical, somatic, unexplained symptoms, complaints, problems; somatised, somatized symptoms; somatisation, somatization, somatoform, psychosomatic; pain; recognition, underrecognition; diagnosis, underdiagnosis; acknowledgment, underacknowledgment; treatment, undertreatment AND primary care, ambulatory care; primary physician; office; general practice; attribution, reattribution; and normalising, normalizing. Only English-language publications and abstracts were considered.Study selection: More than 80 papers related to somatic symptoms in depression were identified using the content of their titles and abstracts.Data synthesis: Approximately two thirds of patients with depression in primary care present with somatic symptoms. These patients are difficult to diagnose, feel an increased burden of disease, rely heavily on health care services, and are harder to treat. Patient and physician factors that prevent discussion of psychological symptoms during consultations must be overcome.Conclusions: Educational initiatives that raise awareness of somatic symptoms in depression and help patients to reattribute these symptoms should help to improve the recognition of depression in primary care.( 3 Despite improved awareness of the condition in primary care, depression remains difficult to diagnose initially, and the majority of cases are only recognized at subsequent consultations, sometimes several years after the patient's initial visit. 4 In primary care, physicians require sophisticated consulting skills to enable them to differentiate a wide range of symptoms from a complex narrative in a short period of time. Symptoms of depression include classic psychological symptoms, such as low mood, loss of interest, poor concentration, and associated anxiety, and somatic symptoms, such as changes in appetite, lack of energy, sleep disturbance, and general aches and pains. 5,6 The suspicion of depression is usually raised by the presence of psychological symptoms. However, in approximately two thirds of patients with depression, the clinical picture is dominated by somatic symptoms, such as lack of energy and general aches and pains, 7,8 which patients frequently attribute to normalizing causes. As a result, many physicians become preoccupied with lengthy investigations into possible underlying organic disease rather than considering depression as a diagnosis.9 Indeed, depression is mostly difficult to recognize in patients who present with chiefly somatic complaints. 8,10 We conducted a review of the recent literature to ascertain the importance of somatic symptoms in depress...