Treating patients for comorbid depression, anxiety disorders, and somatic illnesses

Patients who have comorbid depression and anxiety present primary care physicians a diagnostic as well as a treatment challenge. Identifying these patients is imperative as they have a higher suicide rate than those with depression alone. Patients with major depressive disorder and other psychiatric illness (ie, comorbid generalized anxiety disorder) have a double-fold increase of suicide attempts than patients without comorbid depression. Other medical illnesses may also be comorbid with depression and anxiety. The key to accurate diagnosis is the physician's high index of suspicion, the use of appropriate rating scales for assessment, including patients' self-rating scales, and the team approach. Such scales are also helpful in monitoring progress of treatment and in empowering patients to take an active role in their treatment, which may include pharmacologic or nonpharmacologic treatment options. Patient education in which depression and anxiety are described as biological disorders or medical illnesses averts patients' embarrassment and increases compliance. Referral for psychotherapy also increases compliance. Discussion includes summaries of studies documenting the efficacy, advantages, and disadvantages of medications that have been approved by the US Food and Drug Administration for depression and anxiety. A few medications used off label are mentioned briefly.