Depression in the medical setting: Biopsychological interactions and treatment considerations

This article examines depression in 6 medical conditions: coronary artery d isease (CAD), cancer, human immunodeficiency virus (HIV) infection, Parkins on's disease, pain, and the sex hormone changes of aging. Research is begin ning to define specific biological and psychological mechanisms underlying the adverse interactions between depression and these medical conditions. A ntidepressant medications, psychosocial therapies, and hormonal manipulatio ns are effective in reducing depressive symptoms. Specific psychosocial int erventions may increase longevity in CAD and cancer and may enhance quality of life in HIV infection. Newer antidepressants appear to be safer and bet ter tolerated than older agents for medically ill patients, but do not appe ar to be as effective for neuropathic pain. Dopamine agonists may benefit d epression associated with Parkinson's disease. Hormone replacement therapy may improve subsyndromal depressive symptoms in postmenopausal women and ma y enhance antidepressant response for older women with major depression.