The broad spectrum of comorbid depression: implications for treatment

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.