Depression and Internal Medicine

BACKGROUND Depression is 2-4 times more frequent in medically ill patients than in the general population, it significantly undermines the quality of life and makes prognosis worse in terms of morbidity and mortality. Nevertheless the majority of cases are not recognized or appropriately treated. A growing body of evidence suggests that mood disorders and many medical illnesses are linked in a bidirectional way by several biological mechanisms. Autonomic function changes, hyperactivity of the hypothalamic-pituitary-adrenal axis, increases in plasma cortisol, elevated levels of proinflammatory cytokines, increased platelet activation and hypercoagulability, all of them occur in patients with depression and all of them are causal factors in development and progression of atherothrombotic lesions or they are implicated in the pathogenesis of neoplasm and other illness such as chronic pain, chronic obstructive pulmonary disease, rheumatoid arthritis and so on.
CONCLUSIONS Although antidepressant use has not been shown to reduce mortality rates in patients with medical illness, it alleviates depression, improves the quality of life and reduces morbidity. Clinicians should be aware of this association and should make an effort in detecting and treating not only biological illness but also mood disorders.