Depression is generally diagnosed through the core mood symptoms and a variety of associated emotional and physical symptoms that are persistent during a 2-week period. In primary care, the diagnosis of depression is complicated due to the combination of core mood symptoms and associated symptoms such as painful physical symptoms. 1,3-5 Among primary care patients, 65% of patients with MDD were shown to have some type of painful physical symptoms. 6,7 A greater severity of painful physical symptoms, including back pain, gastrointestinal pain, and headache, is associated with increased severity of depression and reduces quality of life. 8 The presence of painful physical symptoms in patients with depression impairs treatment outcome, 6,7 decreases remission rates, 9 and creates loss of productivity and quality of life. 3,4,10 Patients with residual symptoms, including painful symptoms, are more likely to relapse. 11 Pain in depression receives inadequate attention for treatment due to poor diagnosis. 12 Treatment of depression ideally should include both core mood symptoms and associated symp-