Medical Co-Morbidity in Depressive Disorders

Abstract

Background. Depression is much more prevalent among those with chronic medical conditions compared to the general population of the United States. Depression is recognized as a cause of increased morbidity and mortality and has been associated with higher health care costs, adverse health behaviors, significant functional impairment, lost work productivity, occupational disability and increased health care utilization. Method. Searches of Medline, OVIDMedline, PubMed and PsycINFO of all English-language articles published between 1966 and 2007 were conducted using the keywords mood disorders, medical comorbidity, depression, antidepressant therapy. Supplemental references were manually extracted from relevant articles and chapters. Reviews of mechanistic studies and open label and randomized controlled trials of depression in patients with medical co morbidities were reviewed. Results. Depressive disorders are prevalent among the medically ill and the relationship between depression and medical illness may be bidirectional. Antidepressant medications are effective in the treatment of depression in the medically ill. Conclusions. Depressive disorders can adversely impact the course of medical illnesses. Available antidepressant treatments are effective for the treatment of depression in the medically ill. Early identification and treatment of depression in medical illness can positively influence medical outcomes and quality of life.

Increased Risk of Depression in Patients with Cholesteatoma: A 3-year Nationwide Population-Based Retrospective Cohort Study

“…Poor follow-up compliance is a major concern of surgeons, even in cases where cholesteatoma has been entirely eradicated, due to the difficulties associated with post-operative recidivism, particularly the need for repeated revision surgeries [16]. Second, research has revealed that depression can increase the morbidity of existing medical conditions [5,6,17]. The medical costs of comorbid depression have also been shown to exceed those of medical illness alone.…”

“…The World Health Organization has predicted that depression will continue to be a leading cause of disability, second only to cardiovascular disease by 2020 [19]. A continued increase in disabilities associated with depression implies that many cryptic cases will remain undetected [5,6]. Our discovery of a prospective link between cholesteatoma and depression may serve as an early warning sign for potentially unrecognized DD.…”

“…Patients with cholesteatoma are susceptible to frequent recurrence of foul-smelling otorrhea, hearing impairment, and tinnitus [4]. Depression commonly occurs in the context of medical conditions, with a prolonged impact on patients' quality of life [5]. Thus, it is reasonable to assume that the psychological burden associated with cholesteatoma could cause a patient to become socially withdrawn and potentially lead to the development of depressive disorder (DD).…”

Depression in the Context of Chronic and Multiple Chronic Illnesses

“…Once people develop chronic medical illness, depression is associated with increased symptom burden (perhaps arising from poorer adherence to treatment regimens and poorer perception of medical symptoms), additive functional impairment, greater medical utilisation costs and worse quality of life (Katon and Chiechanowski 2002;Katon 2011). Depressive disorders can adversely impact the course of medical illnesses (Benton, Staab et al 2007) and recent evidence suggests that patients with depression die 5 to 10 years earlier than patients without depression (Chang, Hayes et al 2010). …”

“…It is increasingly clear that the relationship between chronic illness and depression is most likely bidirectional, whereby having depression increases risk of chronic illness, and conversely, having chronic illness increases risk of depression (Benton, Staab et al 2007;Iosifescu 2007;Katon 2011;Renn, Feliciano et al 2011). Conceptual models highlight the complex interactions between risk factors for major depression and chronic medical illness such as genetic and biological vulnerability, childhood adversity, stressful life events, and health risk behaviours such as smoking, sedentary lifestyle and over eating (Katon 2003;Katon 2011).…”