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  • Print publication year: 2013
  • Online publication date: May 2013

13 - Depression in the context of physical illness

from Section 2 - Medical management


Depression secondary to medical illness is an appropriate diagnosis when the physiological effects of the illness on the brain directly result in depressive symptoms. Several medical disorders are associated with depressive symptoms in this way. Occult hypothyroidism exemplifies disorders in which recognition and treatment of the underlying condition may alleviate depression symptoms. In addition to organic causes of depression in the medically ill, other relevant factors to consider and explore with patients include: the meaning of the illness to the patient, the patient's causal attributions about illness, distorted cognitions or maladaptive behavioral responses to illness, coping mechanisms, and strengths or weaknesses which may be imbedded in patients' premorbid personality traits and style. When rapid improvement of depressive symptoms is the goal, psychostimulants have been useful in patients with advanced cancer. The suggestion that antidepressants increase the risk of cancer has been refuted.

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Almeida, O.P., Waterreus, A., and Hankey, G.J. (2006). Preventing depression after stroke: Results from a randomized placebo-controlled trial. The Journal of Clinical Psychiatry, 67, 1104–1109.
Andersen, G., Vestergaard, K., and Lauritzen, L. (1994). Effective treatment of poststroke depression with the selective serotonin reuptake inhibitor citalopram. Stroke, 25, 1099–1104.
Banerjee, S., Hellier, J., Dewey, al. (2011). Sertraline or mirtazapine for depression in dementia (HTA-SADD): a randomised, multicentre, double-blind, placebo-controlled trial. Lancet, 378, 403–411.
Barth, J., Schumacher, M., and Herrmann-Lingen, C. (2004). Depression as a risk factor for mortality in patients with coronary heart disease: a meta-analysis. Psychosomatic Medicine, 66, 802–813.
Berkman, L.F., Blumenthal, J., Burg, al. (2003). Effects of treating depression and low perceived social support on clinical events after myocardial infarction: The Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Randomized Trial. Journal of the American Medical Association, 289, 3106–3116.
Black, S.A., Markides, K.S., and Ray, L.A. (2003). Depression predicts increased incidence of adverse health outcomes in older Mexican Americans with type 2 diabetes. Diabetes Care, 26, 2822–2828.
Bogner, H.R., Morales, K.H., Post, E.P., and Bruce, M.L. (2007). Diabetes, depression, and death: A randomized controlled trial of a depression treatment program for older adults based in primary care (PROSPECT). Diabetes Care, 30, 3005–3010.
Cankurtaran, E.S., Ozalp, E., Soygur, al. (2008). Mirtazapine improves sleep and lowers anxiety and depression in cancer patients: Superiority over imipramine. Supportive Care in Cancer, 16, 1291–1298.
Cohen, S.D., Norris, L., Acquaviva, K., Peterson, R.A., and Kimmel, P.L. (2007). Screening, diagnosis, and treatment of depression in patients with end-stage renal disease. Clinical Journal of the American Society of Nephrology, 2, 1332–1342.
Davidson, K.W., Rieckmann, N., Clemow, al. (2010). Enhanced depression care for patients with acute coronary syndrome and persistent depressive symptoms: coronary psychosocial evaluation studies randomized controlled trial. Archives of Internal Medicine, 170, 600–608.
De Groot, M., Anderson, R., Freedland, K.E., Clouse, R.E., and Lustman, P.J. (2001). Association of depression and diabetes complications: A meta-analysis. Psychosomatic Medicine, 63, 619–630.
Dobkin, R.D., Menza, M., Allen, al. (2011). Cognitive-behavioral therapy for depression in Parkinson's disease: A randomized, controlled trial. The American Journal of Psychiatry, 168, 1066–1074.
Eaton, W.W., Armenian, H., Gallo, J., Pratt, L., and Ford, D.E. (1996). Depression and risk for onset of type II diabetes. A prospective population-based study. Diabetes Care, 19, 1097–1102.
Echeverry, D., Duran, P., Bonds, C., Lee, M., and Davidson, M.B. (2009). Effect of pharmacological treatment of depression on A1C and quality of life in low-income Hispanics and African Americans with diabetes: A randomized, double-blind, placebo-controlled trial. Diabetes Care, 32, 2156–2160.
Ell, K., Katon, W., Xie, al. (2010). Collaborative care management of major depression among low-income, predominantly Hispanic subjects with diabetes: A randomized controlled trial. Diabetes Care, 33, 706–713.
Evans, D.L., McCartney, C.F., Haggerty, J.J., al. (1988). Treatment of depression in cancer patients is associated with better life adaptation: A pilot study. Psychosomatic Medicine, 50, 73–76.
Fallowfield, L., Ratcliffe, D., Jenkins, V., and Saul, J. (2001). Psychiatric morbidity and its recognition by doctors in patients with cancer. British Journal of Cancer, 84, 1011–1015.
Faris, R., Purcell, H., Henein, M.Y., and Coats, A.J. (2002). Clinical depression is common and significantly associated with reduced survival in patients with non-ischaemic heart failure. European Journal of Heart Failure, 4, 541–551.
Ferrando, S.J., Levenson, J.L., and Owen, J.A. (eds.) (2010). Clinical Manual of Psychopharmacology in the Medically Ill. Washington, DC: American Psychiatric Publishing.
Fisch, M.J., Loehrer, P.J., Kristelleret al. (2003). Fluoxetine versus placebo in advanced cancer outpatients: A double-blinded trial of the Hoosier Oncology Group. Journal of Clinical Oncology, 21, 1937–1943.
Fisher, L., Skaff, M.M., Mullan, al. (2008). A longitudinal study of affective and anxiety disorders, depressive affect and diabetes distress in adults with Type 2 diabetes. Diabetic Medicine, 25, 1096–1101.
Fournier, J.C., Derubeis, R.J., Hollon, al. (2010). Antidepressant drug effects and depression severity: A patient-level meta-analysis. Journal of the American Medical Association, 303, 47–53.
Friedman, M., Thoresen, C.E., Gill, al. (1986). Alteration of type A behavior and its effect on cardiac recurrences in post myocardial infarction patients: Summary results of the Recurrent Coronary Prevention Project. American Heart Journal, 112, 653–665.
Gelhorn, H.L., Sexton, C.C., and Classi, P.M. (2011). Patient preferences for treatment of major depressive disorder and the impact on health outcomes: A systematic review. The Primary Care Companion for CNS Disorders, 13.
Georgiades, A., Zucker, N., Friedman, al. (2007). Changes in depressive symptoms and glycemic control in diabetes mellitus. Psychosomatic Medicine, 69, 235–241.
Gibbons, R.D., Hur, K., Brown, C.H., Davis, J.M., and Mann, J.J. (2012). Benefits from antidepressants: Synthesis of 6-week patient-level outcomes from double-blind placebo-controlled randomized trials of fluoxetine and venlafaxine. Archives of General Psychiatry, 69, 572–579.
Glassman, A.H., Roose, S.P., and Bigger, J.T., Jr. (1993). The safety of tricyclic antidepressants in cardiac patients. Risk-benefit reconsidered. Journal of the American Medical Association, 269, 2673–2675.
Glassman, A.H., O’Connor, C.M., Califf, al. (2002). Sertraline treatment of major depression in patients with acute MI or unstable angina. Journal of the American Medical Association, 288, 701–709.
Global Parkinson's Disease Survey Steering Committee (2002). Factors impacting on quality of life in Parkinson's disease: Results from an international survey. Movement Disorders, 17, 60–67.
Goetz, M.P., Knox, S.K., Suman, al. (2007). The impact of cytochrome P450 2D6 metabolism in women receiving adjuvant tamoxifen. Breast Cancer Research and Treatment, 101, 113–121.
Gulliksson, M., Burell, G., Vessby, B., Lundin, L., Toss, H., and Svardsudd, K. (2011). Randomized controlled trial of cognitive behavioral therapy vs. standard treatment to prevent recurrent cardiovascular events in patients with coronary heart disease: Secondary Prevention in Uppsala Primary Health Care project (SUPRIM). Archives of Internal Medicine, 171, 134–140.
Gulseren, L., Gulseren, S., Hekimsoy, Z., and Mete, L. (2005). Comparison of fluoxetine and paroxetine in type II diabetes mellitus patients. Archives of Medical Research, 36, 159–165.
Hesdorffer, D.C., Hauser, W.A., Olafsson, E., Ludvigsson, P., and Kjartansson, O. (2006). Depression and suicide attempt as risk factors for incident unprovoked seizures. Annals of Neurology, 59, 35–41.
Holland, J.C., Romano, S.J., Heiligenstein, J.H., Tepner, R.G., and Wilson, M.G. (1998). A controlled trial of fluoxetine and desipramine in depressed women with advanced cancer. Psycho-oncology, 7, 291–300.
Homsi, J., Nelson, K.A., Sarhill, al. (2001). A phase II study of methylphenidate for depression in advanced cancer. The American Journal of Hospice and Palliative Care, 18, 403–407.
Honig, A., Kuyper, A.M., Schene, al. (2007). Treatment of post-myocardial infarction depressive disorder: A randomized, placebo-controlled trial with mirtazapine. Psychosomatic Medicine, 69, 606–613.
House, A., Knapp, P., Bamford, J., and Vail, A. (2001). Mortality at 12 and 24 months after stroke may be associated with depressive symptoms at 1 month. Stroke, 32, 696–701.
Jiménez Chafey, M.I. and Rosselló, J.M. (2006). Cognitive-behavioral group therapy for depression in adolescents with diabetes: a pilot study. Revista Interamericana de Psicología, 40, 219–226.
Katon, W.J., Simon, G., Russo, al. (2004a). Quality of depression care in a population-based sample of patients with diabetes and major depression. Medical Care, 42, 1222–1229.
Katon, W.J., Von Korff, M., Lin, al. (2004b). The Pathways Study: A randomized trial of collaborative care in patients with diabetes and depression. Archives of General Psychiatry, 61, 1042–1049.
Kessler, R.C., Berglund, P., Demler, al. (2005a). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593–602.
Kessler, R.C., Chiu, W.T., Demler, O., Merikangas, K.R., and Walters, E.E. (2005b). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 617–627.
Kim, D.H., Daskalakis, C., Whellan, al. (2009). Safety of selective serotonin reuptake inhibitor in adults undergoing coronary artery bypass grafting. The American Journal of Cardiology, 103, 1391–1395.
Kim, S.W., Shin, I.S., Kim, al. (2008). Effectiveness of mirtazapine for nausea and insomnia in cancer patients with depression. Psychiatry and Clinical Neurosciences, 62, 75–83.
Kimura, M., Robinson, R.G., and Kosier, J.T. (2000). Treatment of cognitive impairment after poststroke depression: A double-blind treatment trial. Stroke, 31, 1482–1486.
Kroenke, K., Spitzer, R.L., and Williams, J.B. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.
Labos, C., Dasgupta, K., Nedjar, H., Turecki, G., and Rahme, E. (2011). Risk of bleeding associated with combined use of selective serotonin reuptake inhibitors and antiplatelet therapy following acute myocardial infarction. Canadian Medical Association Journal, 183, 1835–1843.
Lee, H.B. and Lyketsos, C.G. (2003). Depression in Alzheimer's disease: Heterogeneity and related issues. Biological Psychiatry, 54, 353–362.
Lesperance, F., Frasure-Smith, N., Koszycki, al. (2007). Effects of citalopram and interpersonal psychotherapy on depression in patients with coronary artery disease: The Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy (CREATE) trial. Journal of the American Medical Association, 297, 367–379.
Levenson, J.L. (ed.) (2011). Textbook of Psychosomatic Medicine: Psychiatric Care of the Medically Ill. Arlington, VA: American Psychiatric Publishing.
Li, M. and Rodin, G. (2011). Depression. In Levenson, J.L., ed., Textbook of Psychosomatic Medicine, Second Edition. Arlington, VA: American Psychiatric Publishing.
Lustman, P.J., Freedland, K.E., Griffith, L.S., and Clouse, R.E. (2000). Fluoxetine for depression in diabetes: A randomized double-blind placebo-controlled trial. Diabetes Care, 23, 618–623.
Lustman, P.J., Griffith, L.S., Freedland, K.E., Kissel, S.S., and Clouse, R.E. (1998). Cognitive behavior therapy for depression in type 2 diabetes mellitus: A randomized, controlled trial. Annals of Internal Medicine, 129, 613–621.
Lustman, P.J., Williams, M.M., Sayuk, G.S., Nix, B.D., and Clouse, R.E. (2007). Factors influencing glycemic control in type 2 diabetes during acute- and maintenance-phase treatment of major depressive disorder with bupropion. Diabetes Care, 30, 459–466.
Lustman, P.J., Griffith, L.S., Clouse, al. (1997). Effects of nortriptyline on depression and glycemic control in diabetes: Results of a double-blind, placebo-controlled trial. Psychosomatic Medicine, 59, 241–250.
Lustman, P.J., Clouse, R.E., Nix, al. (2006). Sertraline for prevention of depression recurrence in diabetes mellitus: A randomized, double-blind, placebo-controlled trial. Archives of General Psychiatry, 63, 521–529.
Massie, M.J. and Miller, K. (2011). Oncology. In Levenson, J.L., ed., Textbook of Psychosomatic Medicine: Psychiatric Care of the Medically Ill, Second Edition. Arlington, VA: American Psychiatric Publishing.
McDonald, W.M., Richard, I.H., and Delong, M.R. (2003). Prevalence, etiology, and treatment of depression in Parkinson's disease. Biological Psychiatry, 54, 363–375.
Morrow, G.R., Hickok, J.T., Roscoe, al. (2003). Differential effects of paroxetine on fatigue and depression: A randomized, double-blind trial from the University of Rochester Cancer Center Community Clinical Oncology Program. Journal of Clinical Oncology, 21, 4635–4641.
O’Connor, C.M., Jiang, W., Kuchibhatla, al. (2010). Safety and efficacy of sertraline for depression in patients with heart failure: results of the SADHART-CHF (Sertraline Against Depression and Heart Disease in Chronic Heart Failure) trial. Journal of the American College of Cardiology, 56, 692–699.
Olin, J. and Masand, P. (1996). Psychostimulants for depression in hospitalized cancer patients. Psychosomatics, 37, 57–62.
Owen, J., and Ferrando, S. (2010). Oncology. In Ferrando, S.L., Levenson, J.L., and Owen, J.A., eds., Clinical Manual of Psychopharmacology in the Medically Ill. Washington, DC: American Psychiatric Publishing.
Paile-Hyvarinen, M., Wahlbeck, K., and Eriksson, J.G. (2003). Quality of life and metabolic status in mildly depressed women with type 2 diabetes treated with paroxetine: A single-blind randomised placebo controlled trial. BMC Family Practice, 4, 7.
Paile-Hyvarinen, M., Wahlbeck, K., and Eriksson, J.G. (2007). Quality of life and metabolic status in mildly depressed patients with type 2 diabetes treated with paroxetine: A double-blind randomised placebo controlled 6-month trial. BMC Family Practice, 8, 34.
Pan, A., Sun, Q., Okereke, O.I., Rexrode, K.M., and Hu, F.B. (2011). Depression and risk of stroke morbidity and mortality: A meta-analysis and systematic review. Journal of the American Medical Association, 306, 1241–1249.
Patten, S.B. and Barbui, C. (2004). Drug-induced depression: A systematic review to inform clinical practice. Psychotherapy and Psychosomatics, 73, 207–215.
Patten, S.B., Williams, J.V., Lavorato, al. (2009). Major depression as a risk factor for high blood pressure: Epidemiologic evidence from a national longitudinal study. Psychosomatic Medicine, 71, 273–279.
Petrak, F. and Herpertz, S. (2009). Treatment of depression in diabetes: An update. Current Opinion in Psychiatry, 22, 211–217.
Price, A., Rayner, L., Okon-Rocha, al. (2011). Antidepressants for the treatment of depression in neurological disorders: A systematic review and meta-analysis of randomised controlled trials. Journal of Neurology, Neurosurgery, and Psychiatry, 82, 914–923.
Rabkin, J., Quitkin, F., Harrison, W., Tricamo, E., and McGrath, P. (1984). Adverse reactions to monoamine oxidase inhibitors. Part I. A comparative study. Journal of Clinical Psychopharmacology, 4, 270–278.
Rasmussen, A., Lunde, M., Poulsen, al. (2003). A double-blind, placebo-controlled study of sertraline in the prevention of depression in stroke patients. Psychosomatics, 44, 216–221.
Robinson, R.G. (2003). Poststroke depression: prevalence, diagnosis, treatment, and disease progression. Biological Psychiatry, 54, 376–387.
Robinson, R.G., Schultz, S.K., Castillo, al. (2000). Nortriptyline versus fluoxetine in the treatment of depression and in short-term recovery after stroke: A placebo-controlled, double-blind study. The American Journal of Psychiatry, 157, 351–359.
Rollman, B.L., Belnap, B.H., Lemenager, al. (2009). Telephone-delivered collaborative care for treating post-CABG depression: A randomized controlled trial. Journal of the American Medical Association, 302, 2095–2103.
Roose, S.P., Dalack, G.W., Glassman, al. (1991). Cardiovascular effects of bupropion in depressed patients with heart disease. The American Journal of Psychiatry, 148, 512–516.
Roose, S.P., Glassman, A.H., Attia, al. (1998a). Cardiovascular effects of fluoxetine in depressed patients with heart disease. The American Journal of Psychiatry, 155, 660–665.
Roose, S.P., Laghrissi-Thode, F., Kennedy, al. (1998b). Comparison of paroxetine and nortriptyline in depressed patients with ischemic heart disease. Journal of the American Medical Association, 279, 287–291.
Rudisch, B. and Nemeroff, C.B. (2003). Epidemiology of comorbid coronary artery disease and depression. Biological Psychiatry, 54, 227–240.
Rugulies, R. (2002). Depression as a predictor for coronary heart disease: A review and meta-analysis. American Journal of Preventive Medicine, 23, 51–61.
Sansone, R.A. and Sansone, L.A. (2009). Warfarin and antidepressants: Happiness without hemorrhaging. Psychiatry, 6, 24–29.
Shapiro, P.A. (2011). Heart disease. In Levenson, J.L., ed., Textbook of Psychosomatic Medicine: Psychiatric Care of the Medically Ill, Second Edition. Arlington, VA: American Psychiatric Publishing.
Simon, G.E., Katon, W.J., Lin, al. (2007). Cost-effectiveness of systematic depression treatment among people with diabetes mellitus. Archives of General Psychiatry, 64, 65–72.
Simson, U., Nawarotzky, U., Friese, al. (2008). Psychotherapy intervention to reduce depressive symptoms in patients with diabetic foot syndrome. Diabetic Medicine, 25, 206–212.
Sood, A., Barton, D.L., and Loprinzi, C.L. (2006). Use of methylphenidate in patients with cancer. The American Journal of Hospice and Palliative Care, 23, 35–40.
Spertus, J.A., McDonell, M., Woodman, C.L., and Fihn, S.D. (2000). Association between depression and worse disease-specific functional status in outpatients with coronary artery disease. American Heart Journal, 140, 105–110.
Steffensmeier, J.J., Ernst, M.E., Kelly, M., and Hartz, A.J. (2006). Do randomized controlled trials always trump case reports? A second look at propranolol and depression. Pharmacotherapy, 26, 162–167.
Stewart, J.A., Deliyannides, D.A., Hellerstein, D.J., McGrath, P.J., and Stewart, J.W. (2012). Can people with nonsevere major depression benefit from antidepressant medication? The Journal of Clinical Psychiatry, 73, 518–525.
Strik, J.J., Honig, A., Lousberg, al. (2000). Efficacy and safety of fluoxetine in the treatment of patients with major depression after first myocardial infarction: Findings from a double-blind, placebo-controlled trial. Psychosomatic Medicine, 62, 783–789.
Tandberg, E., Larsen, J.P., Aarsland, D., and Cummings, J.L. (1996). The occurrence of depression in Parkinson's disease: A community-based study. Archives of Neurology, 53, 175–179.
Taylor, C.B., Youngblood, M.E., Catellier, al. (2005). Effects of antidepressant medication on morbidity and mortality in depressed patients after myocardial infarction. Archives of General Psychiatry, 62, 792–798.
Theoharides, T.C. and Konstantinidou, A. (2003). Antidepressants and risk of cancer: A case of misguided associations and priorities. Journal of Clinical Psychopharmacology, 23, 1–4.
US Food and Drug Administration (2011). FDA Drug Safety Communication: Abnormal Heart Rhythms Associated with High Doses of Celexa (citalopram hydrobromide) [Online]. Available: (accessed October 26 2011).
Van Beljouw, I.M., Verhaak, P.F., Cuijpers, P., Van Marwijk, H.W., and Penninx, B.W. (2010). The course of untreated anxiety and depression, and determinants of poor one-year outcome: A one-year cohort study. BMC Psychiatry, 10, 86.
Van Melle, J.P., De Jonge, P., Spijkerman, al. (2004). Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: A meta-analysis. Psychosomatic Medicine, 66, 814–822.
Veith, R.C., Raskind, M.A., Caldwell, al. (1982). Cardiovascular effects of tricyclic antidepressants in depressed patients with chronic heart disease. The New England Journal of Medicine, 306, 954–959.
Williams, J.W., Jr., Katon, W., Lin, al. (2004). The effectiveness of depression care management on diabetes-related outcomes in older patients. Annals of Internal Medicine, 140, 1015–1024.
Wulsin, L.R. (2004). Is depression a major risk factor for coronary disease? A systematic review of the epidemiologic evidence. Harvard Review of Psychiatry, 12, 79–93.
Wulsin, L.R. and Singal, B.M. (2003). Do depressive symptoms increase the risk for the onset of coronary disease? A systematic quantitative review. Psychosomatic Medicine, 65, 201–210.
Wynn, G., Oesterheld, J., Cozza, K., and Armstrong, S. (2009). Clinical Manual of Drug Interaction Principles for Medical Practice. Arlington, VA: American Psychiatric Publishing, Inc.