It is cruial that clinicians cinsians cosider alternative diagnoses for the presentation as misdiagnosis may prevent patients receiving appropriat treatment. Example of differential diagnoses include delirium, dementia, Parkinson's disease, hypothyroidism, uncontrolled pain, cerebral metastass and adverse drug reaction. It is also important to consider contributory factors. Which if addressed might alleviate the patient's depressive symptoms. Contributory factor may be biological (e.g. hypercalcaemia, uncontrolled psysical symptoms, drug causing depression - e.g. steroids), psychological (e.g. spiritual distress, anger relating ti diagnostic delay) or socila (e.g. family confict, isolation, poor living condition). Another challenge is distinguishing depressive disorder from normal sadness relation to declining healty and fear of death. Patients who are sad usually retain some hope for the future and still derive satisfaction from relationships. Sadness tens to fluctuate, whereas depression is more constant and characterised by self- loathing and a sense of permanence(see Table 3)