Depression in the medically Ill: Diagnostic and therapeutic implications

Abstract

Depression and medical comorbidities lead to increased morbidity and mortality and have been associated with higher health care costs. Depressive disorders can adversely impact the course of medical illnesses, whereas medical illnesses can serve as a risk factor for future depressive disorders. This interplay has spurred some interesting exploratory research to understand the common pathophysiology and neurobiologic substrates that may explain the bidirectional relationship between the two disorders. There is a paucity of well-designed, randomized, controlled trials to address some of the treatment-related prognostic issues in this population. However, more recent studies have focused on diagnostic and treatment implications with various available pharmacologic and psychotherapeutic modalities. Early identification and appropriate treatment of depression in the medically ill can positively influence medical outcomes and quality of life. Collaborative care models integrating mental health and primary care providers, combined with patient preference, are found to be cost-effective and may result in better response to depression treatment.

Deep Brain Stimulation for Treatment-Resistant Depression: Follow-Up After 3 to 6 Years

“…The long-term outcome of depressed patients is characterized by high rates of medical comorbidity and mortality from both suicide and medical illness (25,26), with all-cause mortality rates in treatment-resistant depression estimated in two studies to be 13% over 4-8 years (27) and 32% over 7 years (28). The rate of suicide in depressed patients is frequently cited as 15% (29), based on a follow-up study of severely ill hospitalized patients with a diagnosis of "melancholic depression."…”

Patient preference in psychological treatment and associations with self-reported outcome: national cross-sectional survey in England and Wales

“…Multiple guidelines on the application of evidence-based practise emphasise the use of patient preferences to direct treatment selection, considering it of equal value to symptom profiles, resource availability or past treatment history in guiding management [ 9 , 10 ] Others speculate that understanding patient preference may improve provider-patient communication, encourage patients to engage with treatment and improve adherence [ 11 , 12 ].…”

Incidence of depression in Epilepsy patients

“…These drugs are intended to decrease the overwhelming and recurrent epileptic convulsions. However, scholars and practitioners have identified correlates between medical conditions and depression disorder (Narasimhan, Raynor, & Jones, 2008). Thus, epileptics may suffer from both epilepsy and depression symptoms (Mendez, Cummings, & Benson, 1986, Simms, Atijosan, Kuper, Nuhu, & Rischewski, 2008).…”