It is even more unclear why patients with HF and depression are not more often treated for their depression. As Gottlieb et al. (13) point out, addressing depression in HF patients represents a prime opportunity to truly improve these patients' quality of life. However, only 7% of the patients in this study were taking an antidepressant. Depression commonly goes undiagnosed; some research suggests that 30% to 50% of cases in the general population are never detected by a medical professional (26- 29). Patients may be unwilling to disclose emotional distress to their physicians for fear of being stigmatized with the label of mental illness because they believe their feelings are part of their medical illness or because they don't want a psychiatric diagnosis recorded in their medical record (29- 30). Physicians may not address depression because they have not been adequately trained to recognize both typical and atypical depressive symptoms, because of time constraints in high-volume settings, or because they do not know how to best treat the condition. It is also important to recognize the difficulty inherent in diagnosing depression in the context of a disease with symptoms that mimic depression, particularly in the older population (31- 32). Heart failure often is associated with fatigue, malaise, and insomnia (3), whereas depression is characterized by fatigue, insomnia, low mood, loss of interest in usual activities, weight loss or gain, feelings of worthlessness, and decreased ability to concentrate (29,33). However, it is crucial that both clinicians and patients realize that the presence of major depression is not a standard part of living with HF. Although feeling upset about having a serious disease like HF may be nearly universal, major depression is not a normal reaction to illness and should be recognized as the disabling, chronic, and treatable condition that it is.