Medical Comorbidity Affects Antidepressant Treatment Response in Patients with Melancholic Depression

Abstract

Background: This study aimed at the impact of medical comorbidity (MC) on response to antidepressant treatment over 6 weeks in diagnostic subtypes of patients with major depressive episode (MDE). Methods: In a clinical sample of 241 admitted patients with MDE, MC was assessed by medical specialists and weekly response to antidepressant treatment was assessed with the Hamilton Depression Scale (HAM-D 21). Results: Over 6 weeks of treatment, patients with melancholic depression and MC had poorer treatment response on the HAM-D scale and a worse functional outcome (GAF) as opposed to their counterparts without MC, which was first detected after 4 weeks of treatment (p = 0.02). More specifically, subjects with melancholic depression and cardiovascular or endocrinological MC showed significantly poorer treatment response over 6 weeks. Interestingly, these effects were not related to various antidepressant treatment regimens. Conclusions: MC has a negative impact on treatment response in patients with melancholic depression.

Shared Genetic Liability and Causal Associations Between Major Depressive Disorder and Cardiovascular Diseases

“…Similarly, recognition of shared genetic liability between MDD and CVD suggests the need to evaluate cardiovascular risk in patients with MDD, for example, by using polygenic risk scores (PRS). Since medical comorbidities are also known to contribute to either poor response to antidepressants or treatment resistance ( 77 ), it is tempting to speculate that a stratified allocation of treatment for MDD patients with higher genetic risk for CVD may help both to achieve a better response to SSRIs and to lower the risk for an adverse outcome of CVD.…”

Quality of Life in Medically Ill Persons with Comorbid Mental Disorders: A Systematic Review and Meta-Analysis

“…However, this conclusion is limited by the lack of primary studies on chronic back pain and colorectal cancer as well as on other frequent comorbid mental disorders than depression such as anxiety, somatoform and substance use disorders. Moreover, QoL in patients with comorbid depression may vary with regard to different subtypes of depression in the medically ill such as vascular depression, drug-induced depression, melancholia and adjustment disorders [104,105,106,107,108,109,110]. …”

Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for mood disorders

“…Depression can impede engagement in therapies for comorbid medical conditions thus worsening prognosis. Medical comorbidities – particularly chronic pain – appear to reduce antidepressant efficacy (Bair et al, 2003; Howland et al, 2008; Pohle et al, 2009), but antidepressants still appear to have efficacy over placebo (Gill and Hatcher, 2000). SSRIs are effective in ischemic heart disease and comorbid major depression (Pizzi et al, 2011), and appear more effective than psychological counselling alone (Dickens et al, 2013; Lespérance et al, 2007).…”