Elsevier

Biological Psychiatry

Volume 58, Issue 3, 1 August 2005, Pages 175-189
Biological Psychiatry

Review
Mood Disorders in the Medically Ill: Scientific Review and Recommendations

https://doi.org/10.1016/j.biopsych.2005.05.001Get rights and content

Objective

The purpose of this review is to assess the relationship between mood disorders and development, course, and associated morbidity and mortality of selected medical illnesses, review evidence for treatment, and determine needs in clinical practice and research.

Data Sources

Data were culled from the 2002 Depression and Bipolar Support Alliance Conference proceedings and a literature review addressing prevalence, risk factors, diagnosis, and treatment. This review also considered the experience of primary and specialty care providers, policy analysts, and patient advocates. The review and recommendations reflect the expert opinion of the authors.

Study Selection/Data Extraction

Reviews of epidemiology and mechanistic studies were included, as were open-label and randomized, controlled trials on treatment of depression in patients with medical comorbidities. Data on study design, population, and results were extracted for review of evidence that includes tables of prevalence and pharmacological treatment. The effect of depression and bipolar disorder on selected medical comorbidities was assessed, and recommendations for practice, research, and policy were developed.

Conclusions

A growing body of evidence suggests that biological mechanisms underlie a bidirectional link between mood disorders and many medical illnesses. In addition, there is evidence to suggest that mood disorders affect the course of medical illnesses. Further prospective studies are warranted.

Section snippets

Methods

For this review, the conference cochairs led a development panel in examining the existing literature, assessing weight of evidence, and outlining areas of unmet need that is related to research, clinical practice, and healthcare policy (Evans and Charney 2003). Given the paucity of prospective, randomized, controlled trials, evidence that was provided in expert presentations during the conference also was considered. When evidence was inconclusive or unavailable, the panel relied on

Cardiac Disease

Depression has been shown to increase risk for onset of coronary disease by 1.64-fold (95% confidence interval [CI], 1.41–1.90; Wuslin and Singal 2003) and incident IHD by 1.5- to 2-fold (Abramson et al 2001 Anda et al 1993, Ariyo et al 2000, Ferketich et al 2000, Ford et al 1998), and it predicts morbidity and death in patients with existing cardiac disease (Barefoot and Schroll 1996, Burg et al 2003, Carney et al 1987, Connerney et al 2001, Hermann et al 2000). There is particularly strong

Conclusions

Mood disorders are prevalent in patients with chronic medical illnesses and are more than simply a consequence of medical comorbidity. Presence of depression considerably worsens medical prognosis, because it hinders adherence to treatment regimens, impairs physical and cognitive function, diminishes quality of life, increases morbidity, and in some cases, decreases survival. Depression might be an etiologic factor for incident disease (e.g., cardiac disease, stroke, cancer, epilepsy), which

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