Improving the Care for Depression in Patients With Comorbid Medical Illness

Koike, Alan K.; Unützer, Jürgen; Wells, Kenneth B.

doi:10.1176/appi.ajp.159.10.1738

Cited by 118 publications

(80 citation statements)

References 33 publications

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“…For example, Bogner and colleagues found that, compared to patients without heart disease, patients with heart disease were more likely to be identified as depressed by the primary care physician, but less likely to be actively managed for depression. 29 Koike and colleagues found that rates of depression treatment in patients with medical disorders who participated in a quality improvement program were low despite the greater severity of depression. 30 In summary, such studies demonstrate patterns of practice that downplay the importance of treating depression.…”

Section: Discussionmentioning

confidence: 99%

Multimorbidity, Depression, and Mortality in Primary Care: Randomized Clinical Trial of an Evidence-Based Depression Care Management Program on Mortality Risk

et al. 2015

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Section: Discussionmentioning

confidence: 99%

Multimorbidity, Depression, and Mortality in Primary Care: Randomized Clinical Trial of an Evidence-Based Depression Care Management Program on Mortality Risk

et al. 2015

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“…For these reasons, it is widely advocated that major depression must be appropriately and aggressively treated in patients with chronic somatic disease (Sutor et al 1998 ;Whooley & Simon, 2000 ;Cassano & Fava, 2002). Indeed, appropriate treatment has been found to improve both the course and outcome of depression and the co-morbid somatic disease as well as patient quality of life (Maier & Falkai, 1999 ;Koike et al 2002;Stockton et al 2004).…”

Section: Discussionmentioning

confidence: 99%

Accuracy of diagnosing depression in primary care: the impact of chronic somatic and psychiatric co-morbidity

et al. 2005

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Background. Depression is highly co-morbid with both psychiatric and chronic somatic disease. These types of co-morbidity have been shown to exert opposite effects on underdiagnosis of depression by general practitioners (GPs). However, past research has not addressed their combined effect on underdiagnosis of depression.Method. Co-morbidity data on 191 depressed primary-care patients selected by a two-stage sampling procedure were analysed. Diagnoses of major depression and/or dysthymia in the last 12 months were assessed using a standardized psychiatric interview (CIDI) and compared with depression diagnoses registered by GPs in patient contacts during the same period. Presence of psychiatric and chronic somatic co-morbidity was determined using the CIDI and contact registration, respectively.Results. Regression analysis showed a significant interaction effect between psychiatric and chronic somatic co-morbidity on GPs’ diagnosis of depression, while taking into account the effects of sociodemographic variables, depression severity and number of GP contacts. Subsequent stratified analysis revealed that in patients without chronic somatic co-morbidity, a lower educational level, a less severe depression, and fewer GP contacts all significantly increased the likelihood of not being diagnosed as depressed. In contrast, in patients with chronic somatic co-morbidity, only having no psychiatric co-morbidity significantly decreased the likelihood of receiving a depression diagnosis.Conclusions. Our results indicate that the effects of psychiatric co-morbidity and other factors on underdiagnosis of depression by GPs differ between depressed patients with and without chronic somatic co-morbidity. Efforts to improve depression diagnosis by GPs seem to require different strategies for depressed patients with and without chronic somatic co-morbidity.

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“…82 Organized follow-up programs that include patient education, telephone or in-person contact every 2 to 4 weeks, monitoring of medication adherence, and psychiatric consultation as necessary improve outcomes for depressed cardiac patients. [83][84][85][86] "Measurement-based care," which uses frequent ratings of symptoms and adverse effects to guide dose adjustments and changes in treatment, can also be of benefit. 87 If antidepressant medication does not improve symptoms by 4 weeks and adverse effects are tolerable, the initial medication dose should be doubled.…”

Section: How Should Cardiac Patients Be Followed Up After Initiating mentioning

confidence: 99%

Depression and Cardiovascular Disease

Whooley¹

2006

JAMA

218

163

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Major depressive disorder is a risk factor for the development of incident coronary heart disease events in healthy patients and for adverse cardiovascular outcomes in patients with established heart disease. Depression is present in 1 of 5 outpatients with coronary heart disease and in 1 of 3 outpatients with congestive heart failure, yet the majority of cases are not recognized or appropriately treated. It is not known whether treating depression improves cardiovascular outcomes, but antidepressant treatment with selective serotonin reuptake inhibitors is generally safe, alleviates depression, and improves quality of life. This article evaluates the importance of major depression in patients with cardiovascular disease, and provides practical guidance for identifying and treating this disorder. CASE PRESENTATIONA 58-year-old man with a history of coronary heart disease (CHD), type 2 diabetes mellitus, hypertension, smoking, and alcohol dependence presented for routine medical care. He had initially sought medical attention for exertional angina 5 years previously, at which time he underwent exercise treadmill testing with thallium that was positive for reversible perfusion defects in the anterior, septal, and inferior walls. Subsequent coronary angiography revealed diffuse heavy calcifications in the left anterior descending artery with a moderate lesion prior to the first diagonal. Several major septal perforators had significant lesions at their origins. In the dominant right coronary artery, there were diffuse calcifications but no significant lesions. The left circumflex and large ramus intermedius were free of discrete lesions. Left ventricular function was normal.The patient underwent single-vessel (left internal mammary artery to left anterior descending artery) coronary artery bypass grafting (CABG) surgery. He was prescribed atenolol 100 mg/ d, lisinopril 40 mg/d, lovastatin 80 mg/d, aspirin 325 mg/d, metformin 850 mg 3 times a day, and glipizide 10 mg 2 times a day. Despite being nonadherent to his prescribed medications, he remained stable for 5 years, but then one day, while doing household chores, he suddenly developed chest pressure, shortness of breath, and diaphoresis that lasted 12 hours. On admission to the hospital his troponin I was elevated and peaked at 0.7 ng/mL (normal, <0.05 ng/mL), consistent with a myocardial infarction (MI). His electrocardiogram had not changed.

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Improving the Care for Depression in Patients With Comorbid Medical Illness

Cited by 118 publications

References 33 publications

Multimorbidity, Depression, and Mortality in Primary Care: Randomized Clinical Trial of an Evidence-Based Depression Care Management Program on Mortality Risk

Multimorbidity, Depression, and Mortality in Primary Care: Randomized Clinical Trial of an Evidence-Based Depression Care Management Program on Mortality Risk

Accuracy of diagnosing depression in primary care: the impact of chronic somatic and psychiatric co-morbidity

Depression and Cardiovascular Disease

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