McCoy D M
J Fam Pract. 1996 Dec;43(6 Suppl):S35-44.
In addition to being a strong psychological stressor in itself, medical illness is associated with risk factors that predispose patients to develop coexisting depression. Patients with conditions such as cancer, cardiovascular disease, and neurologic disorders are particularly prone to depression because these illnesses are severe, chronic, and often fatal. Because an antidepressant may exacerbate an underlying illness, leading to more serious side effects, agents with a poor tolerability profile or that act at multiple receptor sites should be avoided. In many cases, this precludes the use of tricyclic antidepressants and monoamine oxidase inhibitors, and favo's the use of selective serotonin reuptake inhibitors and other new antidepressants because they have fewer anticholinergic, cardiac, or cognitive adverse effects. Depressed medically ill patients clearly benefit from antidepressant therapy. Because mental health influences prognosis and treatment outcome, primary care physicians should maintain a high index of suspicion for depression in patients with significant medical illness and aggressively treat the condition when indicated.
除了本身就是一种强烈的心理压力源外，医学疾病还与一些危险因素相关，这些因素使患者易患并存的抑郁症。患有癌症、心血管疾病和神经系统疾病等病症的患者特别容易患抑郁症，因为这些疾病严重、慢性且往往致命。由于抗抑郁药可能会加重潜在疾病，导致更严重的副作用，因此应避免使用耐受性差或作用于多个受体部位的药物。在许多情况下，这排除了三环类抗抑郁药和单胺氧化酶抑制剂的使用，而倾向于使用选择性5-羟色胺再摄取抑制剂和其他新型抗抑郁药，因为它们具有较少的抗胆碱能、心脏或认知方面的不良反应。患有医学疾病的抑郁症患者显然从抗抑郁治疗中受益。由于心理健康会影响预后和治疗结果，初级保健医生应对患有重大医学疾病的患者保持高度的抑郁症怀疑指数，并在有指征时积极治疗该病症。
