Treatment considerations for depression in patients with significant medical comorbidity.

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.