Management of depression in medical patients

The management of depression in the medically ill is a complex task that requires considerable clinical skills. The aim of this review is to outline evaluation strategies which may lead to a more effective use of current psychiatric diagnostic criteria and to suggest clinical guidelines for the use of antidepressant medications and psychotherapeutic techniques. The multifactorial determinants and modes of expression of depression in the medical patient require further research. Treatment outcome studies involving drug treatment or short-term psychotherapeutic approaches or both are needed. Antidepressant drugs remain the most specific and readily available treatment of major depressive disorders in the setting of medical disease. In case of organic affective syndromes, treatment should be primarily directed to the physical condition.