Background: The Canadian Psychiatric Association and the Canadian Network f
or Mood and Anxiety Treatment partnered to produce clinical guidelines for
psychiatrists for the treatment of depressive disorders.
Methods: A standard guidelines development process was followed. Relevant l
iterature was identified using a computerized Medline search supplemented b
y review of bibliographies. Operational criteria were used to rate the qual
ity of scientific evidence, and the line of treatment recommendations inclu
ded consensus clinical opinion. This section, on Axis I, and Axis II, and A
xis III comorbidity, is 1 of 7 articles that were drafted and reviewed by c
linicians. Revised drafts underwent national and international expert peer
review.
Results: Comorbid depression on Axis I is particularly prevalent in patient
s with anxiety disorders, substance and use disorders, and eating disorders
, but it also occurs in patients with schizophrenia, attention-deficit hype
ractivity disorder (ADHD), and dementia. Depressive comorbidity has implica
tions for assessment, management, and outcome. The relation between depress
ion and personality disorders is complex. Patients with this comorbidity of
ten require longer, more intense, and multimodal therapies. Depression is a
lso prevalent in medical illnesses, requires careful diagnosis, and respond
s to standard antidepressant treatments.
Conclusions: Comorbidity can influence the course and outcome of both assoc
iated conditions. Depression-specific psychotherapy and/or pharmacotherapy
should be considered with comorbid depression is diagnosed.