Editors

SamiPirkola

Depression, Drugs and Somatic Diseases

Depression is a common disorder related to other psychiatric and somatic diseases, and it often complicates the diagnosis and treatment.
According to various studies 20-60% of patients with general medical conditions have symptoms of depression and 15-45% fulfil the criteria of a mood disorder.
Remember somatic diseases that may cause depression (table T1).
Rule out possible drugs and narcotic substances that may cause mood disorders (table T1).
The role of somatic differential diagnosis is especially emphasized:
- in elderly patients with no previous mood disorders
- in patients with atypical symptoms of depression
- in patients who do not benefit from traditional treatment of depression
In a patient with somatic disease it is not always easy to differentiate the somatic symptoms from those of depression.
A somatic disease may contribute to the development of depression both through a direct physiological and an indirect psychological reaction formation.
The potential interactions with the medications used for somatic diseases should be taken into account when starting drug treatment for depression.

Depression is especially related to:
- stroke, memory disease and Parkinson's disease
- hypothyroidism, hyperparathyroidism
- diabetes and coronary heart disease
- cancer
- fibromyalgia.
Depressive patients have an increased risk of myocardial infarction. After myocardial infarction, depression as a comorbid disorder increases mortality from heart diseases. Inadequate response to antidepressant medication in a patient with coronary heart disease may be associated with vascular factors.
Depression may also predispose to cancer. There is a small but clinically significant association with depression and incidence of cancer.
Bariatric surgery has been shown to reduce depression in overweight persons. This is presumably mediated through an indirect psychological effect.

Medical conditions
Stroke
B₁-, B₂-, B₆- ja B₁₂-vitamin deficiencies
Folic acid deficiency
Diabetes
Hyperthyroidism
Hypothyroidism
Hyperadrenalism (Cushing's syndrome)
Hypoadrenalism (Addison's disease, hypopituitarism)
Hyperparathyroidism
Hypoparathyroidism
Parkinson's disease
Porphyria
Coronary artery disease
Status post infarctum
Neoplasms
Temporal lobe epilepsy
Uraemia
Pharmacological agents
Anabolic steroids
Antipsychotic drugs
Beta-blockers
Estrogens
Digitalis
Clonidine
Corticosteroids
Methyldopa
Ranitidine
Anticholinergics
Psychoactive substances
Alcohol
Amphetamine (during withdrawal)
Ecstasy (MDMA)
Cocaine (during withdrawal)

Frasure-Smith N, Lespérance F. Recent evidence linking coronary heart disease and depression. Can J Psychiatry 2006 Oct;51(12):730-7. [PubMed]
Celano CM, Huffman JC. Depression and cardiac disease: a review. Cardiol Rev 2011 May-Jun;19(3):130-42. [PubMed]
Frasure-Smith N, Lespérance F. Reflections on depression as a cardiac risk factor. Psychosom Med 2005 May-Jun;67 Suppl 1():S19-25. [PubMed]
Habra ME, Baker B, Frasure-Smith N, Swenson JR, Koszycki D, Butler G, van Zyl LT, Lespérance F. First episode of major depressive disorder and vascular factors in coronary artery disease patients: Baseline characteristics and response to antidepressant treatment in the CREATE trial. J Psychosom Res 2010 Aug;69(2):133-41. [PubMed]