Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2011;13(1):7-23.
doi: 10.31887/DCNS.2011.13.1/wkaton.

Epidemiology and treatment of depression in patients with chronic medical illness

Wayne J Katon  1
Affiliations
Review

Epidemiology and treatment of depression in patients with chronic medical illness

Wayne J Katon. Dialogues Clin Neurosci. 2011.

Abstract
in English, Spanish, French

There is a bidirectional relationship between depression and chronic medical disorders. The adverse health risk behaviors and psychobiological changes associated with depression increase the risk for chronic medical disorders, and biological changes and complications associated with chronic medical disorders may precipitate depressive episodes. Comorbid depression is associated with increased medical symptom burden, functional impairment, medical costs, poor adherence to self-care regimens, and increased risk of morbidity and mortality in patients with chronic medical disorders. Depression may worsen the course of medical disorders because of its effect on proinflammatory factors, hypothalamic-pituitary axis, autonomic nervous system, and metabolic factors, in addition to being associated with a higher risk of obesity, sedentary lifestyle, smoking, and poor adherence to medical regimens. Both evidence-based psychotherapies and antidepressant medication are efficacious treatments for depression. Collaborative depression care has been shown to be an effective way to deliver these treatments to large primary care populations with depression and chronic medical illness.

Hay una relación bidireccional entre la depresión y los trastornos médicos crónicos. Las conductas de riesgo adversas para la salud y los cambios psicobiológicos asociados con la depresión aumentan el riesgo de trastornos médicos crónicos, y los cambios biológicos y las complicaciones asociadas con los trastornos médicos crónicos pueden precipitar episodios depresivos. La depresión comórbida está asociada con un aumento de las repercusiones de los síntomas médicos, del deterioro funcional, de los costos médicos, de una pobre adherencia a los regímenes de auto-cuidado, y un mayor riesgo de morbilidad y mortal idad en los pacientes con trastornos médicos crónicos. La depresión puede empeorar la evolución de los trastornos médicos debido a su efecto sobre los factores proinflamatorios, en el eje hipotálamo-hipofisiario, en el sistema nervioso autónomo y sobre los factores metabólicos, además de estar asociada con un mayor riesgo de obesidad, de un estilo de vida sedentario, de tabaquismo y de una pobre adherencia a los tratamientos médicos. Tanto las psicoterapias basadas en la evidencia como los fármacos antidepresivos son tratamientos eficaces para la depresión. Los modelos de atención en salud de tipo colaborativo aplicados a la depresión han demostrado ser una forma efectiva para entregar estos tratamientos a grandes poblaciones de pacientes en atención primaria con depresión y enfermedades médicas crónicas.

La dépression et les pathologies chroniques sont liées à double titre. Les comportements à risque délétères pour la santé et les modifications psychobiologiques associés à la dépression augmentent le risque de pathologies chroniques, tandis que les complications et modifications biologiques associées aux pathologies chroniques peuvent précipiter des épisodes dépressifs. La dépression, chez les patients présentant des pathologies chroniques, est associée à une augmentation de la charge symptomatique, à une détérioration fonctionnelle, à des coûts médicaux, à une mauvaise observance de l'autosurveillance et à une augmentation du risque de morbidité et de mortalité.. Elle peut aggraver le cours des maladies à cause de ses effets sur les facteurs pro-inflammatoires, sur l'axe hypothalamohypophysaire, sur le système nerveux autonome et sur les facteurs métaboliques, avec en plus un risque majoré d'obésité, de vie sédentaire, de tabagisme et de mauvaise observance des traitements médicaux. Les psychothérapies validées et les antidépresseurs sont deux approches utiles pour traiter la dépression. La prise en charge de la dépression de manière collaborative est efficace pour soigner un grand nombre de patients traités en soins primaires atteints de dépression comorbide de pathologies chroniques.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.. Bidirectional interaction between depression and chronic medical disorders. Reproduced from ref 14: Katon WJ. Clinical and health services relationships between major depression, depressive symptoms, and general medical illness Biol Psychiatry. 2003;54:216-226. Copyright © Elsevier, 2003
Figure 2.
Figure 2.. Relationship of depression and diabetes complications to 10 diabetes symptoms. Reproduced from ref 60: Ludman EJ, Katon W, Russo J, et al. Depression and diabetes symptom burden. Gen Hosp Psychiatry. 2004;26:430-436. Copyright © Elsevier 2004
Figure 3.
Figure 3.. Psychophysiologic effects of depression. HPA, hypothalamicpituitary-adrena Adapted from ref 102: Champaneri S, Wand GS, Malhotra SS, Casagrande SS, Golden SH. Biological basis of depression in adults with diabetes. Curr Diab Rep. 2010;10:396-405. Copyright © Current Science 2010
See this image and copyright information in PMC

References

    1. Chang CK HR., Broadbent M., Fernandes AC., Lee W., Hotopf M., Stewart R. All-cause mortality among people with serious mental illness (SMI), substance use disorders, and depressive disorders in southeast London: acohort study. BMC Psychiatry. 2010;10:77. - PMC - PubMed
    1. Roshanaei-Moghaddam B., Katon W. Premature mortality from general medical illness among persons with bipolar disorder: a review. . Psychiatr Serv. 2009;60:147–156. - PubMed
    1. Katon W., Russo J., Lin EH., et al. Depression and diabetes: factors associated with major depression at five-year follow-up. . Psychosomatics. 2009;50:570–579. - PMC - PubMed
    1. Kennedy GJ., Kelman HR., Thomas C. Persistence and remission of depressive symptoms in late life. . Am J Psychiatry. 1991;148:174–178. - PubMed
    1. Ali S., Stone MA., Peters JL., Davies MJ., Khunti K. The prevalence of comorbid depression in adults with Type 2 diabetes: a systematic review and meta-analysis. . Diabet Med. 2006;23:1165–1173. - PubMed

Publication types