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Chapter 25 - Mood Disorders: Therapeutic Challenges in the Medically Ill Patient

Published online by Cambridge University Press:  16 May 2024

By
Peter A. Shapiro ,
Luis Pereira ,
Jon A. Levenson  and
Chineze Worthington
Edited by
Allan Young ,
Marsal Sanches ,
Jair C. Soares  and
Mario Juruena
Allan Young
Affiliation:
Institute of Psychiatry, King's College London
Marsal Sanches
Affiliation:
Baylor College of Medicine, Texas
Jair C. Soares
Affiliation:
McGovern Medical School, The University of Texas
Mario Juruena
Affiliation:
King's College London
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Summary

Mood disorders are more common in persons with medical illness than in the general population, and add to suffering, morbidity, and mortality. As to diagnosis, emotional states seen in the context of illness range from denial to bland indifference to “normal” sadness, to pathological anxiety and depressive or manic syndromes. Within this range fall both primary mood disorders and mood disorders secondary to the primary illness and its treatment.Treatment is complicated by difficulties with patient engagement and retention, limited clinical trial data, illness-related sensitivity to medications and alterations in drug metabolism, drug side effects, and drug interactions. Limited data are available about potentially valuable treatments such as exercise, transcranial magnetic stimulation, ketamine and psychedelics. Collaborative care models for depression treatment in medical settings are effective but demanding to implement and sustain. Special considerations apply to treatment of patients near the end of life and those requesting hastened death. Psychiatric treatment of the medically ill patient can evoke strong feelings in the treatment provider.

Keywords

Mood disordersdifferential diagnosisdepressionpsychopharmacologypsychotherapyend-of-life caremedical illness
Type
Chapter
Information
Clinical Textbook of Mood Disorders , pp. 263 - 276
Publisher: Cambridge University Press
Print publication year: 2024

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Save book to Dropbox

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Save book to Google Drive

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