An understanding of the existence and action of depression is essential to the medical management of patients with chronic illness. This study found thirteen unique patterns of depression in depressed persons being treated for chronic medical conditions. Of the 132 persons sampled, 96.2% fell clearly into one of these groups. The fact that these people manifested their clinical depression in such a variety of ways argues against a unilateral approach to the treatment of affective distress among those with a chronic medical illness. While patients manifest their affective distress in a variety of ways, self-esteem issues are significantly involved in almost half of the identified patterns.