[Depression in the medically ill: diagnosis and treatment considerations in C-L psychiatry settings]

Depression in general hospital patients is one of the main psychiatric problems in the medically ill. It often complicates the treatment and prognosis of patients with active medical conditions. However, depression in the medically ill is frequently under-recognized and under-treated. This article reviews the historical concept of secondary depression, and gives an overview of medical conditions and medications associated with depression. Phenomenological issues in the diagnosis of depression in medically ill populations and treatment considerations in C-L psychiatry settings will be discussed. The authors have used the examples of Parkinson's disease and epilepsy commonly associated with depression to illustrate how these considerations affect the C-L psychiatrist's choice of an antidepressant in the medically ill.