Comorbidity between major depressive disorder and physical diseases: a comprehensive review of epidemiology, mechanisms and management

Abstract

Populations with common physical diseases – such as cardiovascular diseases, cancer and neurodegenerative disorders – experience substantially higher rates of major depressive disorder (MDD) than the general population. On the other hand, people living with MDD have a greater risk for many physical diseases. This high level of comorbidity is associated with worse outcomes, reduced adherence to treatment, increased mortality, and greater health care utilization and costs. Comorbidity can also result in a range of clinical challenges, such as a more complicated therapeutic alliance, issues pertaining to adaptive health behaviors, drug‐drug interactions and adverse events induced by medications used for physical and mental disorders. Potential explanations for the high prevalence of the above comorbidity involve shared genetic and biological pathways. These latter include inflammation, the gut microbiome, mitochondrial function and energy metabolism, hypothalamic‐pituitary‐adrenal axis dysregulation, and brain structure and function. Furthermore, MDD and physical diseases have in common several antecedents related to social factors (e.g., socioeconomic status), lifestyle variables (e.g., physical activity, diet, sleep), and stressful live events (e.g., childhood trauma). Pharmacotherapies and psychotherapies are effective treatments for comorbid MDD, and the introduction of lifestyle interventions as well as collaborative care models and digital technologies provide promising strategies for improving management. This paper aims to provide a detailed overview of the epidemiology of the comorbidity of MDD and specific physical diseases, including prevalence and bidirectional risk; of shared biological pathways potentially implicated in the pathogenesis of MDD and common physical diseases; of socio‐environmental factors that serve as both shared risk and protective factors; and of management of MDD and physical diseases, including prevention and treatment. We conclude with future directions and emerging research related to optimal care of people with comorbid MDD and physical diseases.

Postpartum Depression and Inflammatory Biomarkers of Neutrophil-Lymphocyte Ratio, Platelet-Lymphocyte Ratio, and Monocyte-Lymphocyte Ratio: A Prospective Observational Study

“…Several risk factors have been identified for PPD, including previous depression, postnatal stress, and inadequate support during the postpartum period [8][9][10]. However, recent studies have suggested that other factors, including subclinical inflammation, may also play a key role in the pathogenesis of major depression and of PPD [11][12][13]. The number of studies investigating the potential association between inflammation and the onset of PPD is limited [14].…”

Translation of clinical practice guidelines on lifestyle behavior in a psychiatric setting. A discourse analytical case study

“…Manifested by increased mortality 1 and somatic comorbidity, 2,3 unhealthy lifestyle behavior such as unhealthy diet, alcohol abuse, inactivity and smoking, is common in people with psychiatric diseases. Therefore, a wide range of nutrition guidance, physical activity and smoking interventions emerge globally in psychiatric settings.…”

Potential antidepressant effects of Traditional Chinese botanical drug formula Chaihu-Shugan-San and its active ingredients

“…This high level of comorbidity is associated with worse outcomes, reduced treatment compliance, increased mortality rates, higher healthcare utilization, and costs. Comorbidities can also lead to a range of clinical challenges, including more complex treatment regimens, issues related to adaptive health behaviors, drug interactions, and adverse events caused by medications used for both physical and mental disorders ( Berk et al, 2023 ). There are numerous risk factors associated with the onset of depression, including stress, pain, physical illnesses, and cognitive decline.…”