From the Department of Psychiatry (Thom, Silbersweig, Boland), Brigham and Women's Hospital; and Harvard Medical School (Thom, Silbersweig, Boland), Boston, Massachusetts.
Psychosom Med. 2019 Apr;81(3):246-255. doi: 10.1097/PSY.0000000000000678.
Major depression, as well as other depressive disorders, is commonly comorbid with other medical illnesses, particularly chronic and systemic medical illnesses. The co-occurrence of the disorders is so common that it challenges our notions of the meaning of comorbidity and our desire to neatly separate psychiatric and medical illnesses. The overlap between symptoms of physical illness and the neurovegetative symptoms of major depression and the initial normative emotional response to physical illness add to the challenge of accurate diagnosis and timely treatment of depression in the medically ill. We review the literature on the comorbidity of depression and the various medical illnesses, including diagnostic and treatment approaches. The differential diagnosis for major depression among medically ill patients should include delirium and medication-induced symptoms. We suggest that major depression itself may be best conceptualized as a systemic illness whose pathophysiology overlaps with other systemic medical illnesses. The initial treatment strategies for major depression in medical illness are like those for the general population; however, the comorbid medical illnesses may interfere with remission. To illustrate these points, we describe a patient with clinical characteristics covered in this review who experienced major depression as well as several chronic illnesses, including hypersensitivity pneumonitis, multiple sclerosis, chronic pain due to degenerative joint disease, and diabetes mellitus.
重度抑郁症，以及其他抑郁障碍，通常与其他医学疾病共病，特别是慢性和系统性医学疾病。这些疾病的同时发生非常普遍，这挑战了我们对共病含义的理解，以及我们希望将精神疾病和医学疾病分开的愿望。身体疾病的症状与重度抑郁症的神经植物性症状以及对身体疾病的初始正常情绪反应之间的重叠，增加了准确诊断和及时治疗患有医学疾病的抑郁症的难度。我们回顾了关于抑郁症和各种医学疾病共病的文献，包括诊断和治疗方法。患有医学疾病的重度抑郁症患者的鉴别诊断应包括谵妄和药物引起的症状。我们认为，重度抑郁症本身最好被视为一种全身性疾病，其病理生理学与其他全身性医学疾病重叠。患有医学疾病的重度抑郁症的初始治疗策略与一般人群相同；然而，共病的医学疾病可能会干扰缓解。为了说明这些要点，我们描述了一位具有本综述中涵盖的临床特征的患者，他患有重度抑郁症以及几种慢性疾病，包括过敏性肺炎、多发性硬化症、退行性关节病引起的慢性疼痛和糖尿病。
