Depression

doi:10.1017/CBO9780511544590.042

39 - Depression

Published online by Cambridge University Press: 12 January 2010

Edward R. Norris and

Edited by

Nathan O. Spell and

Edward R. Norris: Affiliation:
Department of Psychiatry, Lehigh Valley Hospital & Health Network, Allentown, PA
Charles L. Raison: Affiliation:
Department of Psychiatry & Behavioral Sciences, Atlanta, GA
Michael F. Lubin: Affiliation:
Emory University, Atlanta
Robert B. Smith: Affiliation:
Emory University, Atlanta
Thomas F. Dodson: Affiliation:
Emory University, Atlanta
Nathan O. Spell: Affiliation:
Emory University, Atlanta
H. Kenneth Walker: Affiliation:
Emory University, Atlanta

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Summary

Depressive disorders are the most common psychiatric problem seen in medical–surgical patients. The point prevalence rate for depression is 10%–36% for general medical inpatients. The presence of depression has a significant effect on the patient's morbidity and mortality. Patients with depression following a myocardial infarction are 3.5 times more likely to die in the next 6 months than patients without depression.

The causes of depression in medically ill patients are multiple, including dealing with loss, helplessness, pain, lowered self-esteem, and financial and marital strain after illness. In many cases, depressive symptoms may result from the underlying physical illness or medications used in treatment.

Most depressive reactions in medical–surgical patients are relatively short, resolve after surgery, and do not cause major disturbances in social, occupational, interpersonal, physical, or psychological functioning. If depressive symptoms persist, they become major depression.

Major depression is characterized by a markedly depressed mood or loss of interest or pleasure in life (see Table 39.1). This depressed mood lasts longer than 2 weeks and causes significant disruptions in patient's occupational, social, and interpersonal functioning. Physical symptoms of depression can include sleep disturbances, appetite disturbance or weight change, fatigue, and physical feelings of being slowed down. Emotional symptoms can include disinterest, apathy, low self-esteem, hopelessness, helplessness, and guilt. Some patients will have suicidal thoughts or active plans for suicide. When severe, depression in the medically ill may give rise to psychotic symptoms, including paranoia, hallucinations, delusions (including somatic delusions of insect infestation), and obsessive–compulsive behavior.

Type: Chapter
Information: Medical Management of the Surgical Patient
A Textbook of Perioperative Medicine
, pp. 479 - 492

DOI: https://doi.org/10.1017/CBO9780511544590.042 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2006

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References

Wells, C. E.Pseudodementia. Am. J. Psychiatry 1979; 136: 895–890.Google Scholar PubMed

McAllister, T. W.Overview: pseudodementia. Am. J. Psychiatry 1983; 140: 528–533.Google Scholar PubMed

Dubin, W. R. Psychiatric emergencies: recognition and management. In Stoudemire, A., ed. Clinical Psychiatry for Medical Students. Philadelphia: J. B. Lippincott, 1990; 497–526.Google Scholar

Marks, R. M. & Sachar, E. J.Undertreatment of medical inpatient with narcotic analgesics. Ann. Intern. Med. 1973; 78: 173–181.CrossRef Google Scholar PubMed

Goldberg, R. J. Acute pain management. In Stoudemire, A. & Fog, B. S., eds. Psychiatric Care of the Medical Patient. New York: Oxford University Press, 1993: 323–339.Google Scholar

Knorring, L.The experience of pain in depressed patients. Neuropsychobiology 1975; 1: 155–165.CrossRef Google Scholar PubMed

Hameroff, S. R., Cork, R. C., Scherer, K.et al. Doxepin effects chronic pain, depression and plasma opioids. J. Clin. Psychiatry 1982; 43: 22–27.Google Scholar PubMed

Ward, N. G., Bloom, V. L., & Friedel, R. O.The effectiveness of tricyclic antidepressants in the treatment of coexisting pain and depression. Pain 1979; 7: 331–341.CrossRef Google Scholar PubMed

Portenoy, R. K. Chronic pain management. In Stoudemire, A. & Fogel, B. S., eds. Psychiatric Care of the Medical Patient. New York: Oxford University Press, 1993: 341–366.Google Scholar

Stoudemire, A. Organic mental disorders. In Stoudemire, A.Clinical Psychiatry for Medical Students. Philadelphia: J. B. Lippincott, 1990: 72–103.Google Scholar

Carroll, B. J.Dexamethasone suppression test: a review of temporary confusion. J. Clin. Psychiatry 1985; 46: 13–24.Google Scholar

Glassman, A. H., Johnson, L. L. O., Giardina, E. G. V.et al. The use of imipramine in depressed patients with congestive heart failure. J. Am. Med. Assoc. 1983; 250: 1997–2001.CrossRef Google Scholar PubMed

Veith, R. C., Raskind, M. A., Caldwell, J. H.et al. Cardiovascular effects of tricyclic antidepressants in depressed patients with chronic heart disease. N. Engl. J. Med. 1982; 306: 954–959.CrossRef Google Scholar PubMed

Siris, S. G. & Rifkin, A.The problem of psychopharmacotherapy in the medically ill. Psychiatr. Clin. North Am. 1981; 4: 379–390.Google Scholar PubMed

Robinson, D. S., Nies, A., Corcella, J.et al. Cardiovascular effects of phenelzine and amitriptyline in depressed outpatients. J. Clin. Psychiatry 1982; 43: 8–15.Google Scholar PubMed

Zisook, S.A clinical overview of monoamine oxidase inhibitors. Psychosomatics 1985; 26: 240–251.CrossRef Google Scholar PubMed

Stoudemire, A., Fogel, B. S., Gulley, L. R., & Moran, M. G. Psychopharmacology in the medically ill. In Stoudemire, A. & Fogel, B. S., eds. Psychiatric Care of the Medical Patient. New York: Oxford University Press, 1993: 155–206.Google Scholar

Katon, W. & Raskind, M.Treatment of depression in the medically ill elderly with methylphenidate. Am. J. Psychiatry 1980; 137: 963–965.Google Scholar PubMed

McKenna, G., Engle, R. P., Brooks, H.et al. Cardiac arrhythmias during electroshock therapy: significance, prevention and treatment. Am. J. Psychiatry 1970; 127: 530–533.CrossRef Google Scholar PubMed

Weiner, R.ECT in the physically ill. J. Psychiatr. Treat. Eval. 1983; 5: 457–462.Google Scholar

Weiner, R. D. & Coffey, C. E. Electroconvulsive therapy in the medical and neurologic patient. In Stoudemire, A. & Fogel, B. S., eds. Psychiatric Care of the Medical Patient. New York: Oxford University Press, 1993: 207–224.Google Scholar

Alpert, J. E., Bernstein, J. G., & Rosenbaum, J. F. Psychopharmacologic issues in the medical setting. In Cassem, N. H., Stern, T. A., Rosenbaum, J. F., & Jellinek, M. S., eds. The Massachusetts General Hospital Handbook of General Hospital Psychiatry, 4th edn. St. Louis: Mosby, 1997: 249–303.Google Scholar

Glassman, A. H., Rodriguez, A. I., & Shapiro, P. A.The use of antidepressant drugs in patients with heart disease. J. Clin. Psychiatry 1998; 59(Suppl. 10): 16–21.Google Scholar PubMed

Goff, D. C. & Shader, R. I. Non-neurological side effects of antipsychotic agents. In Hirsch, S. R. & Weinberger, D. R., eds. Schizophrenia. Oxford: Blackwell Science, 1995: 566–578.Google Scholar

Grebb, J. A. General principles of psychopharmacology. In Kaplan, H. I. & Sadock, B. J., eds. Comprehensive Textbook of Psychiatry VI, 6th edn. Baltimore: Williams and Wilkins, 1995: 1895–1915.Google Scholar

Hyman, S. E., Arana, G. W., & Rosenbaum, J. F.Handbook of Psychiatric Drug Therapy, 3rd edn. Boston: Little, Brown, 1995.Google Scholar

Smoller, J. A., Pollack, M. H., & Lee, D. K. Management of antidepressant-induced side effects. In Stern, T. A., Herman, J. B., & Slavin, P. S., eds. The MGH Guide to Psychiatry in Primary Care. New York: McGraw-Hill, 1998: 483–496.Google Scholar

Tesar, G. E. Cardiovascular side effects of psychotropic agents. In Stern, T. A., Herman, J. B., & Slavin, P. S., eds. The MGH Guide to Psychiatry in Primary Care. New York: McGraw-Hill, 1998: 497–517.Google Scholar

Thapa, P. B., Gideon, P., Cost, T. W., Milam, A. B., & Ray, W. A.Antidepressants and the risk of falls among nursing home residents. N. Engl. J. Med. 1998; 339: 875–882.CrossRef Google Scholar PubMed

Stoudemire, A. Depression. In Lubin, M. F., Walker, H. K., & Smith, R. B., eds. Medical Management of the Surgical Patient. Philadelphia, PA: J. B. Lippincott Company, 1995: 430–437.Google Scholar

Norris, E. R. & Cassem, N. Cardiovascular and other side effects of psychotropic medications. In Stern, T. & Herman, J., eds. Psychiatry Update and Board Preparation, New York: McGraw-Hill Publishers, 2000: Chapter 39.Google Scholar

Guggenheim, F. Somatoform disorders. In Sadock, B. J. & Sadock, A. V., eds. Comprehensive Textbook of Psychiatry. Philadelphia, PA: J. B. Lippincott, Williams and Wilkins, 1999: 1504–1532.Google Scholar

Barsky, A. J.The patient with hypochondriasis. N. Engl. J. Med. 2001: 345(19), 1395–1399.CrossRef Google Scholar PubMed

Berlin, R. M.The management of insomnia in hospitalized patients. Ann. Intern. Med. 1984; 100: 398–404.CrossRef Google Scholar PubMed

Brown, J. T., Mulrow, C. D., & Stoudemire, A.The anxiety disorders. Ann. Intern. Med. 1984; 100: 558–564.CrossRef Google Scholar PubMed

Folks, D. G., Ford, C. V., & Houck, C. A. Somatoform disorders, factitious disorders, and malingering. In Stoudemire, A., ed. Clinical Psychiatry for Medical Students. Philadelphia: J. B. Lippincott, 1990: 237–268.Google Scholar

Folks, D. G. & Houck, C. A. Somatoform disorders, factitious disorders and malingering. In Stoudemire, A. & Fogel, B. S., eds. Psychiatric Care of the Medical Patient. New York: Oxford University Press, 1993: 267–288.Google Scholar

Goldberg, R. J. & Posner, D. Anxiety in the medically ill. In Stoudemire, A. & Fogel, B. S., eds. Psychiatric Care of the Medical Patient. New York: Oxford University Press, 1993: 87–104.Google Scholar

Goldberg, R. J. & Posner, D. A. Anxiety in the medically ill. In Stoudemire, A., Fogel, B. S., & Greenberg, D. B., eds. Psychiatric Care of the Medical Patient. New York: Oxford University Press, 2000: 165–180.Google Scholar

Greenblatt, D. J., Shader, R. I., & Abernathy, D. R.Current status of benzodiazepines. N. Engl. J. Med. 1983; 309: 410–416.Google Scholar PubMed

Phillips, K. A., Albertini, R. S., & Rasmussen, S. A.A randomized placebo-controlled trial of fluoxetine in body dysmorphic disorder. Arch. Gen. Psychiatry 2002: 59(4), 381–388.CrossRef Google Scholar PubMed

Schuckit, M. A.Anxiety related to medical disease. J. Clin. Psychiatry 1983; 44: 31–37.Google Scholar PubMed

Stoudemire, A. Anxiety and somatoform disorders. In Lubin, M. F., Walker, H. K., & Smith, R. B., eds. Medical Management of the Surgical Patient. Philadelphia, PA: J. B. Lippincott, 1995: 438–443.Google Scholar

Green, S. A. Principles of medical psychotherapy. In Stoudemire, A. & Fogel, B. S., eds. Psychiatric Care of the Medical Patient. New York: Oxford University Press, 1993: 3–18.Google Scholar

Baudry, F. & Weiner, A. The surgical patient. In Strain, J. & Grossman, S., eds. Psychological Care of the Medically Ill: A Primer in Liaison Psychiatry. New York: Appleton-Century-Crofts, 1975: 123–137.Google Scholar

Strain, J. The surgical patient. In Cavenar, J., ed. Psychiatry. Philadelphia: J. B. Lippincott, 1986: 1–11.Google Scholar

Egbert, L. D., Battit, G. E., Welch, C. D., & Bartlett, M. K.Reduction of postoperative pain by encouragement and instruction of patient. N. Engl. J. Med. 1964; 270: 825–827.CrossRef Google Scholar

Egbert, L. D., Bartlet, G. E., Taldorf, H., & Beecher, H. K.The value of preoperative visits by the anesthetist. J. Am. Med. Assoc. 1963; 185: 553–555.CrossRef Google Scholar

Layne, O. L. Jr. & Yudofsky, S. C.Postoperative psychosis in cardiotomy patients: the role of organic and psychiatric factors. N. Engl. J. Med. 1971; 284: 518–520.CrossRef Google Scholar PubMed

Lazarus, H. R. & Hagens, T. H.Prevention of psychosis following open-heart surgery. Am. J. Psychiatry 1968; 124: 1190–1195.CrossRef Google Scholar PubMed

Andrew, J. M.Recovery from surgery, with and without preparatory instruction, for three coping styles. J. Pers. Soc. Psychol. 1970; 15: 223–226.CrossRef Google Scholar PubMed

Reading, A. E.The short-term effects of psychological preparation for surgery. Soc. Sci. Med. 1979; 13A: 641–654.Google Scholar PubMed

Stoudemire, A. Psychologic and emotional reactions to illness and surgery. In Lubin, M. F., Walker, H. K., & Smith, R. B., eds. Medical Management of the Surgical Patient. Philadelphia, PA: J. B. Lippincott Company, 1995: 427–429.Google Scholar