Common Medical Disorders and the Risk of Developing Depression

Stoudemire A. Psychosomatics 1996;37:504-8.

A number of studies have been conducted examining the relationship of health status, functional status and stressful life events in the situation of a chronic, life-threatening illness. In one study (van Servellen et al, 1996), poorer functional status and greater negative stressors experienced by men with cancer or AIDS were shown to be associated with higher levels of hopelessness and depression; 62% of the study group met the criteria for clinical depression. Further, Lyketsos et al (1996) found significant increases in all depressive symptoms in HIV-positive men as AIDS developed, beginning as early as 18 months before clinical AIDS was diagnosed.

Studies have also found that major depression significantly increases morbidity and mortality in patients with CAD. Complicating this is the fact that some classes of antidepressants present cardiac risks. Tricyclic antidepressants can alter cardiac conduction and contractility, and can cause antiarrhythmic activity which can increase the risk of sudden death. Data also indicate that tricyclics may affect heart rate and rhythm. (Evans et al, 1996). Tricyclics should therefore be avoided within the 3 month period following a myocardial infarction. (Pary et al, 1989). The SSRIs may produce arrhythmias, atrial fibrillation, bradycardia, supraventricular tachycardia and heart blockage. (Shaline et al, 1997).

Other chronic conditions that present a potential risk for development of depression include arthritis, stroke, metabolic and endocrine disorders such as hypo- or hyperthyroidism; diabetes; Parkinson's disease and Alzheimer's disease. Chronic alcohol abuse similarly has been linked with a high incidence of comorbid depression - although which of the two is the preceding factor is often difficult to determine.

Antidepressant therapy is effective and can contribute to improved quality of life for HIV/AIDS or cancer patients. The SSRIs and newer agents may be particularly well suited for use in depressed patients with a chronic medical condition because they lack the significant adverse anticholinergic and cardiovascular effects of tricyclic and other classes of antidepressants.

Please see:

Section I: "Making The Diagnosis"
CANMAT – Guidelines for the Diagnosis and Pharmacological Treatment of Depression
(1st Edition Rev., 1999)
P. 11

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