[The importance of depressive disorders in somatic medicine]

Depressive disorders--including mild and subthreshold forms--are frequent in medical patients, although often not recognized. Over the past decades accumulating scientific evidence has demonstrated their clinical relevance. Depressive disorders and also elevated scores on self-rating scales for depressive symptoms are clearly related to disease behavior and quality of life. In many physical conditions they also predict adverse outcome, including premature death. This paper gives an overview of the literature on the relevance and treatment of comorbid depression in patients with HIV infection, cancer and coronary heart disease. It shows that the subjective effects of depression are rather similar in different somatic conditions. In addition, depression also interacts with the physical course of different diseases. However, the specific physiological mediators involved vary among different somatic diseases and have not yet been completely understood. Despite this uncertainty an improved recognition and treatment of comorbid depression can be recommended. Supportive interventions focussing on coping demands as well as regular psychotherapy and in some cases antidepressant medication may be indicated. While it still appears premature to establish generally applicable treatment guidelines, an individualized approach with regard to the different treatment alternatives for individual patients should be advocated.