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The broad spectrum of comorbid depression: implications for treatment

Published online by Cambridge University Press:  16 April 2020

J Mendlewicz
J Mendlewicz*
Affiliation:
Cliniques University de Bruxelles, Service de Psychiatrie, Hôpital Erasme, Route de Lennick 808, 1070Brussels, Belgium
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Summary

There is a high rate of depression in patients with medical or other psychiatric disorders. This comorbid depression is associated with an increased morbidity and mortality from medical illness, poor compliance with treatment, a worsening of somatic symptoms, and often a decrease in functional status. Several recent studies have demonstrated that comorbid depression is highly treatable and that effective treatment often enhances patients' adaptive coping with medical illness. However, when choosing antidepressant therapy, care must be taken to evaluate the patient's illness fully and to avoid potential drug-drug interactions and drug-related illness. This review investigates the use of antidepressants in depressed patients with medical and psychiatric disorders and their effect on prognosis and morbidity, and suggests that there is a place for the use of antidepressant medications in the treatment of comorbid conditions. Generally, the greater safety and tolerability of the selective serotonin reuptake inhibitors provides improved options for the treatment of depression in the medically and psychiatrically ill.

Keywords

comorbiddepressionSSRIs
Type
Review
Information
European Psychiatry , Volume 13 , Issue 1 , 1998 , pp. 1 - 8
Copyright
Copyright © Elsevier, Paris 1998

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References

Anderson, M, Tomenson, BM. The efficacy of selective serotonin re-uptake inhibitors in depression: a meta-analysis of studies against tricyclic antidepressants J Psychopharmacol 1994; 8: 238–249CrossRefGoogle ScholarPubMed
Anderson, M, Tomenson, BMTreatment discontinuation with selective serotonin reuptake inhibitors compared with tricyclic antidepressants: a meta-analysis BMJ 1995; 310: 1433–1438CrossRefGoogle ScholarPubMed
Baldwin, D, Rudge, S. The role of serotonin in depression and anxiety Int Clin Psychopharmacol 9 Suppl 4 1995 41–45CrossRefGoogle ScholarPubMed
Berken, GH, Weinstein, DO, Stern, WC. Weight gain: a sideeffect of tricyclic antidepressants J Affective Disord 1984; 7: 133–138CrossRefGoogle Scholar
Bowen, DJ, Spring, B, Fox, E. Tryptophan and high-carbohydrate diets as adjuncts to smoking cessation therapy J Behav Med 1991; 11: 17–34Google Scholar
Boyer, W. Serotonin uptake inhibitors are superior to imipramine and alprazolam in alleviating panic attacks: a meta analysis Int Clin Psychopharmacol 1995; 10: 45–49CrossRefGoogle ScholarPubMed
Boyer, WF, Feighner, JPSide-effects of the selective serotonin re-uptake inhibitorsPerspectives in Psychiatry Volume I, Selective Serotonin Re-uptake Inhibitors Chichester: John Wiley, 1991 133–152Google Scholar
Boyer, WF, McFadden, GA, Feighner, JPThe efficacy of selective serotonin re-uptake inhibitors in anxiety and obsessive-compulsive disorderFeighner, JP, Boyer, WFPerspectives in Psychiatry Volume I, Selective Serotonin Re-uptake Inhibitors Chichester: John Wiley, 1991 109–117Google Scholar
Bryson, HM, Wilde, MI. Amitriptyline. A review of its pharmacological properties and therapeutic use in chronic pain states Drugs Aging 1996; 8: 459–476CrossRefGoogle ScholarPubMed
Carney, R, Rich, MW, Freedland, K. Major depressive disorder predicts cardiac events in patients with coronary heart disease Psychosom Med 1988; 50: 627–633CrossRefGoogle Scholar
Cassano, GB, Musetti, L, Soriani, A, Savino, M. The pharmacologic treatment of depression: drug selection criteria Pharmacopsychiatry 1993; 26: 17–23CrossRefGoogle ScholarPubMed
Clayton, PJ. The co-morbidity factor: establishing the primary diagnosis in patients with mixed symptoms of anxiety and depression J Clin Psychiatry 1990; 51: 35–39Google ScholarPubMed
Coryell, W, Endicott, J, Andreasen, NC. Depression and panic attacks: the significance of overlap as reflected in follow-up and family study data Am J Psychiatry 1988; 145: 293–300Google ScholarPubMed
Coulehan, JL, Schulberg, HC, Block, MR, Janosky, JE, Arena, VC. Medical co-morbidity of major depressive disorder in a primary medical practice Arch Intern Med 1990; 150: 2363–2367CrossRefGoogle Scholar
Creed, F, Ash, G. Depression in rheumatoid arthritis: aetiology and treatment Int Rev Psychiatry 1992; 4: 23–34CrossRefGoogle Scholar
Cummings, JL. Depression and Parkinson's disease: a review J Clin Psychiatry 1992; 149: 443–454Google ScholarPubMed
Cunningham, LA. Depression in the medically ill: choosing an antidepressant J Clin Psychiatry 55Suppl A1994 90–97Google ScholarPubMed
Dalack, GW, Roose, SP. Perspectives on the relationship between cardiovascular disease and affective disorder J Clin Psychiatry 1990; 51: 4–9Google ScholarPubMed
Davis, R, Whittington, R, Bryson, HM. Nefazodone. A review of its pharmacology and clinical efficacy in the management of major depression Drugs 1997; 53: 608–636CrossRefGoogle ScholarPubMed
Dunbar, GC, Cohn, JB, Fabre, LF. A comparison of paroxetine, imipramine, and placebo in depressed out-patients Br J Psychiatry 1991; 159: 394–398CrossRefGoogle ScholarPubMed
Eison, MS. Serotonin: a common neurobiologic substrate in anxiety and depression J Clin Psychopharmacol 1990; 10: 26–30CrossRefGoogle ScholarPubMed
Fawcett, J. Targeting treatment in patients with mixed symptoms of anxiety and depression J Clin Psychiatry 1990; 51: 40–43Google ScholarPubMed
Feighner, JP, Boyer, WF, Meredith, CH, Hendrickson, GG. A double-blind comparison of fluoxetine, imipramine, and placebo in outpatients with major depression Int Clin Psychopharmacol 1989; 4: 127–134CrossRefGoogle ScholarPubMed
Feighner, JP, Cohn, JB, Fabre, LF et al. A study comparing paroxetine, placebo and imipramine in depressed patients J Affective Disord 1993; 28: 71–79CrossRefGoogle ScholarPubMed
Feighner, JP. Cardiovascular safety in depressed patients: focus on venlafaxine J Clin Psychiatry 1995; 56: 574–579Google ScholarPubMed
Feldman, E, Mayou, R, Hawton, K, Smith, EB. Psychiatric disorder in medical inpatients Q J Med 1987; 63: 405–412Google Scholar
Fernandez, F. Depression and its treatment in cardiac patients Texas Heart Institute J 1993; 20: 188–197Google ScholarPubMed
Fernstrom, MH, Kowinski, RL, Kupfer, DJ. Appetite and food preference in depression: effects of imiprimine treatment Biol Psychiatry 1987; 22: 529–539CrossRefGoogle Scholar
Fielding, R. Depression and acute myocardial infarction: A review and reinterpretation Soc Sci Med 1991; 32: 1017–1027CrossRefGoogle ScholarPubMed
Finkelstein, SP, Weintraub, RJ, Karmouz, N. Anti-depressant drug treatment for post-stroke depression: retrospective study Arch Phys Med Rehabil 1987; 68: 772–776Google Scholar
Fisch, C. Effect of fluoxetine on the electrocardiogram J Clin Psychiatry 1985; 46: 42–44Google ScholarPubMed
Frank, RG, Kashani, JH, Parker, JC et al. Antidepressant analgesia in rheumatoid arthritis J Rheumatol 1988; 15: 1632–1638Google ScholarPubMed
Frasure-Smith, N, Lespérance, F, Talajic, M. Depression following myocardial infarction: impact on 6-month survival JAMA 1993; 270: 1819–1825CrossRefGoogle ScholarPubMed
Glassman, AH, Preud'Homme, XA. Review of the cardiovascular effects of heterocyclic antidepressants J Clin Psychiatry 54Suppl 21993 16–22Google ScholarPubMed
Glassman, AH, Roose, SP, Bigger, JT Jr. The safety of tricyclic antidepressants in cardiac patients. Risk-benefit considered JAMA 1993; 269: 2673–2675CrossRefGoogle Scholar
Gonzalez Torrecillas, JI, Mendlewicz, J, Lobo, A. Effects of early treatment of poststroke depression on neuropsychological rehabilitation Int Psychogeriatr 1995; 7: 547–560CrossRefGoogle ScholarPubMed
Gonzalez Torrecillas, JI, Mendlewicz, J, Lobo, A. Analysis of intensity of post-stroke depression and its relationship with the cerebral lesion location Med Clin (Bare) 1997; 109: 241–244Google ScholarPubMed
Goodnick, PJ, Henry, JH, Buki, VM. Treatment of depression in patients with diabetes mellitus J Clin Psychiatry 1995; 56: 128–136Google ScholarPubMed
Goodnick, PJ, Kumar, A, Henry, JH, Buki, VM, Goldberg, RB. Sertraline in coexisting major depression and diabetes mellitus Psychopharmacol Bull 3321997 261–264Google ScholarPubMed
Goldberg, DP, Lecrubier, YForm and frequency of mental disorders access centersÜstün, TB, Sartorius, NMental illness in general health care United Kingdom: Wiley, 1995 323–334Google Scholar
Greenberg, MS, Stiglin, LE, Finkelstein, SN, Berndt, ER. Depression: a neglected major illness J Clin Psychiatry 1993; 54: 419–424Google ScholarPubMed
Grunhaus, L. Clinical and psychobiological characteristics of simultaneous panic disorder and major depression Am J Psychiatry 1988; 145: 1214–1221Google ScholarPubMed
Henderson, R, Kurlan, R, Kersun, JM, Como, P. Preliminary examination of the co-morbidity of anxiety and depression in Parkinson's disease J Neuropsychiatry Clin Neurosci 1992; 4: 257–264Google ScholarPubMed
Hunter, B Depression associated with rheumatoid arthritis — comparison of paroxetine and amitriptyline. Poster presented at 10th European College of Neuropsychopharmacology Congress Vienna, Austria September 1997Google Scholar
Ibbotson, T, Maguire, P, Selby, P, Priestman, T, Wallace, L. Screening for anxiety and depression in cancer patients: the effects of disease and treatment Eur J Cancer 1994; 30: 37–40CrossRefGoogle Scholar
Judge, R, Steiner, M. The long-term efficacy and safety of paroxetine in panic disorder Eur Neuropsychopharmacol 6suppl 31996 207–CrossRefGoogle Scholar
Kasper, S, Zivkov, M, Roes, KC, Pols, AG. Pharmacological treatment of severely depressed patients: a meta-analysis comparing efficacy of mirtazapine and amitriptyline Eur Neuropsychopharmacol 1997; 7: 115–124CrossRefGoogle ScholarPubMed
Katon, W, Sullivan, MD. Depression and chronic medical illness J Clin Psychiatry 51Suppl 61990 3–11Google ScholarPubMed
Katz, PP, Yelin, EH. Prevalence and correlates of depressive symptoms among persons with rheumatoid arthritis J Rheumatol 1993; 20: 790–796Google ScholarPubMed
Keller, MB, Hanks, DL. Anxiety symptom relief in depression treatment outcomes J Clin Psychiatry 56Suppl 61995 22–29Google ScholarPubMed
Kessler, RC, McGonagle, KA, Zhao, S et al.Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey Arch Gen Psychiatry 5111994 8–19CrossRefGoogle ScholarPubMed
Kessler, RC, Nelson, CB, McGonagle, KA, Liu, J et al.Comorbidity of DSM-III-R major depressive disorder in the general population: results from the US National Comorbidity Survey Br J Psychiatry 1996; 30: 17–30CrossRefGoogle Scholar
Le Cavorzin, PH, Sarkis, S, Beneton, Cet al. Fluvoxamine et syndrome serotoninerique chez un malade pakinsonien Therapie 1996; 51: 191–196Google Scholar
Lecrubier, Y, Bourin, M, Moon, CAL, Schifano, Fet al. Efficacy of venlafaxine in depressive illness in general practice Acta Psychiatr Scand 1997; 95: 485–493CrossRefGoogle ScholarPubMed
Lydiard, RB. Co-morbidity of panic disorder, phobia and major depression Eur Psychiatry 10Suppl 21995 65s–66sCrossRefGoogle ScholarPubMed
Lund, J, Thayssen, P, Mengel, H, Pedersen, OL, Kristensen, CD, Gram, LF. Paroxetine: pharmacokinetics and cardiovascular effects after oral and intravenous single doses in man Acta Pharmacol Toxicol (Copenhagen) 1982; 51: 351–357CrossRefGoogle ScholarPubMed
McDaniel, JS, Musselman, DL, Porter, MR, Reed, DA, Nemeroff, CB. Depression in patients with cancer. Diagnosis, biology and treatment Arch Gen Psychiatry 1995; 52: 89–99CrossRefGoogle Scholar
Massie, MJ, Holland, JC. Depression and the cancer patient J Clin Psychiatry 1990; 51: 12–17Google ScholarPubMed
Mancini, C, Ameringen, MV. Paroxetine in social phobia J Clin Psychiatry 1996; 57: 519–522CrossRefGoogle ScholarPubMed
Mayeux, R, Stern, Y, Cote, L, Williams, JB. Altered serotonin metabolism in depressed patients with Parkinson's disease Neurology 1984; 34: 642–646CrossRefGoogle ScholarPubMed
Mayeux, R, Stern, Y, Williams, JB, Cote, L, Frantz, A, Drenforth, I. Clinical and biochemical features of depression in Parkinson's disease Am J Psychiatry 1986; 143: 756–759Google ScholarPubMed
Meredith, L, Wells, K, Camp, P. Clinician speciality and treatment style for depressed outpatients with and without medical comorbidities Arch Fam Med 1994; 3: 1065–1072CrossRefGoogle Scholar
Montgomery, SA. SSRIs: Well tolerated treatment for depression Hum Psychopharmacol 9S11994 7–10CrossRefGoogle Scholar
Montgomery, SA, Prost, JF, Solles, A, Briley, M. Efficacy and tolerability of milnacipran: an overview Int Clin Psychopharmacol 11 suppl 4 1996 47–51CrossRefGoogle ScholarPubMed
Morganroth, J, Goin, JE. Quinidine-related mortality in the short-to-medium-term treatment of ventricular arrhythmias: a metaanalysis Circulation 1991; 84: 1977–1983CrossRefGoogle Scholar
Murphy, JM, Olivier, DC, Sobol, AM, Monson, RR, Leighton, AH. Diagnosis and outcome: depression and anxiety in a general population Psychol Med 1986; 16: 117–126CrossRefGoogle Scholar
Nelson, JC. Safety and tolerability of the new antidepressants J Clin Psychiatry 58 suppl 6 1997 26–31Google ScholarPubMed
Parker, JC, Wright, GE. The implications of depression for pain and disability in rheumatoid arthritis Arth Care Res 1995; 8: 279–283CrossRefGoogle ScholarPubMed
Puech, A, Montgomery, SA, Prost, JF, Solles, A, Briley, M. Milnacipran, a new serotonin and noradrenaline reuptake inhibitor: an overview of its antidepressant activity and clinical tolerability Int Clin Psychopharmacol 1997; 12: 99–108CrossRefGoogle ScholarPubMed
Rechlin, T. The effect of amitriptyline, doxepin, fluvoxamine, and paroxetine treatment on heart rate variability J Clin Psychopharmacol 1994; 14: 392–395CrossRefGoogle ScholarPubMed
Reding, MJ, Orto, LA, Winter, SW, Fortuna, IM, DiPonte, P, McDowell, FH. Anti-depressant therapy after stroke, a doubleblind trial Arch Neurol 1986; 43: 763–765CrossRefGoogle Scholar
Richard, IH, Kurlan, R. A survey of antidepressant drug use in Parkinson's disease. Parkinson Study Group Neurology 1997; 49: 1168–1170CrossRefGoogle ScholarPubMed
Rifkin, A. Depression in physically ill patients Postgrad Med 1992; 92: 146–154CrossRefGoogle ScholarPubMed
Robinson, DS, Roberts, DL, Smith, JM, Stringfellow, JCet al. The safety profile of nefazodone J Clin Psychiatry 57suppl 21996 31–38Google ScholarPubMed
Roose, SP, Dalack, GW. Treating the depressed patient with cardiovascular problems J Clin Psychiatry 1992; 53: 25–31Google ScholarPubMed
Rubin, N. Severe asthma and depression Arch Fam Med 1993; 12: 433–439CrossRefGoogle Scholar
Schleifer, SJ, Macari-Hinson, MM, Coyle, DAet al. The nature and course of depression following myocardial infarction Arch Intern Med 1989; 149: 1785–1789CrossRefGoogle ScholarPubMed
Schleifer, SJ, Macari-Hinson, MM, Coyle, DAet al. The nature and course of depression following myocardial infarction Arch Intern Med 1989; 149: 1785–1789CrossRefGoogle ScholarPubMed
Schneier, FR, Johnson, J, Hornig, CD, Liebowitz, MR, Weissman, MM. Social phobia: comorbidity and morbidity in an epidemiologic sample Arch Gen Psychiatry 1992; 49: 282–288CrossRefGoogle Scholar
Sommi, RW, Crismon, ML, Bowden, CI. Fluoxetine: a serotonin specific, second generation antidepressant Pharmacotherapy 1987; 7: 1–15CrossRefGoogle ScholarPubMed
Stimmel, GL, Dopheide, JA, Stahl, SM. Mirtazapine: an antidepressant with noradrenergic and specific serotonergic effects Pharmacotherapy 1997; 17: 10–21Google ScholarPubMed
Suchowersky, O, deVries, TO. Interaction of fluoxetine and selegiline [letter] Can J Psychiatry 1990; 53: 571–572CrossRefGoogle Scholar
Teri, L, Wagner, A. Alzheimer's disease and depression J Consult Clin Psychiatry 1992; 60: 379–391CrossRefGoogle ScholarPubMed
The Cardiac Arrhythmia Suppression Trial (CAST) Investigators Preliminary report: effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction New Engl J Med 1989; 321: 406–412CrossRefGoogle Scholar
The Cardiac Arrhythmia Suppression Trial II Investigators Effect of the antiarrhythmic agent moricizine on survival after myocardial infarction New Engl J Med 1992; 327: 227–233CrossRefGoogle Scholar
Tiller, JWG. Post-stroke depression Psychopharmacology 1992; 106: S130–S133CrossRefGoogle ScholarPubMed
Toyama, SC, Iacono, RP. Is it safe to combine a selective serotonin reuptake inhibitor with selegiline? Annals of Pharmacotherapy 1994; 28: 405–406CrossRefGoogle Scholar
Van Loon, BJP, Radder, JK, Fröhlich, M, Krans, HM, Zwinderman, AH, Meindes, AE. Fluoxetine increases insulin action in obese nondiabetic and in obese non-insulin dependent diabetic individuals Int J Obesity 1992; 16: 79–85Google Scholar
Verrier, RL. Neurochemical approaches to the prevention of ventricular fibrillation Fed Proc 1986; 45: 2191–2196Google ScholarPubMed
Wallen, J, Pincus, HA, Goldman, HH. Psychiatric consultations in short-term general hospitals Arch Gen Psychiatry 1987; 44: 163–188CrossRefGoogle ScholarPubMed
Weiss, DM. Serotonin syndrome in Parkinson disease J Am Board Family Practice 1995; 8: 400–402Google ScholarPubMed
Wells, KB, Stewart, A, Hays, RDet al. The functioning and wellbeing of depressed patients JAMA 1989; 262: 914–919CrossRefGoogle Scholar
Wells, KB, Burnham, MA, Rogers, W, Hays, R, Camp, P. The course of depression in adult outpatients. Results from the Medical Outcomes Study Arch Gen Psychiatry 1992; 49: 788–794CrossRefGoogle ScholarPubMed
Wells, KB, Rogers, W, Burnam, MA, Camp, P. Course of depression in patients with hypertension, myocardial infarction, or insulin-dependent diabetes Am J Psychiatry 1993; 150: 632–638Google ScholarPubMed
Wiart, L. Post-cerebrovascular stroke depression Encephale 1997; 23: 51–54Google ScholarPubMed
Williams, RB, Chesney, MA. Psychosocial factors and prognosis in established coronary artery disease: the need for research on interventions JAMA 1993; 270: 1860–1861CrossRefGoogle ScholarPubMed
Wolkow, R, Apter, J, Clayton, Aet al. Double-blind flexible dose study of sertraline and placebo in patients with panic disorder. Presented at the 20th CINP Melbourne Australia June 1996CrossRefGoogle Scholar
Zohar, J, Judge, R the OCD Paroxetine Study Investigators Paroxetine versus clomipramine in the treatment of obsessivecompulsive disorder Br J Psychiatry 1996; 169: 468–474CrossRefGoogle Scholar
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