TREATMENT CONSIDERATIONS FOR DEPRESSION IN PATIENTS WITH SIGNIFICANT MEDICAL COMORBIDITY

In addition to being a strong psychological stressor in itself, medica l illness is associated with risk factors that predispose patients to develop coexisting depression. Patients with conditions such as cancer , cardiovascular disease, and neurologic disorders are particularly pr one to depression because these illnesses are severe, chronic, and oft en fatal. Because an antidepressant may exacerbate an underlying illne ss, leading to more serious side effects, agents with a poor tolerabil ity profile or that act at multiple receptor sites should be avoided. In many cases, this precludes the use of tricyclic antidepressants and monoamine oxidase inhibitors, and favors the use of selective seroton in reuptake inhibitors and other new antidepressants because they have fewer anticholinergic, cardiac, or cognitive adverse effects. Depress ed medically ill patients clearly benefit from antidepressant therapy. Because mental health influences prognosis and treatment outcome, pri mary care physicians should maintain a high index of suspicion for dep ression in patients with significant medical illness and aggressively treat the condition when indicated.