Depression in medical patients

Depression is a major problem in medical patients. It is a problem that has been generally under-recognized and under-treated, highly associated with somatized symptoms, loss of function, and increased medical utilization. Obviously more training needs to be provided in this area for non-psychiatric physicians, as well as other primary care providers. Much of what guides recognition and treatment of depression in medical patients has been derived from studies of depression in non-medical populations. However, it is not completely clear that depression in medical populations is the same problem as that seen in the mental health care setting. Furthermore, the majority of psychopharmacology studies have been done in patients with no medical conditions. There are, fortunately, increasing numbers of drug and ECT studies in specific medical populations as well as outcome studies in medically ill depressed patients. There has been increasing recognition that in the primary care setting, less severe depressive symptom constellations are a common problem. This so-called "sub-syndromal" depression is an area of great interest but little understanding. There is no well researched information on such depressions in terms of natural course, response to treatment, or relation to other disorders such as anxiety disorders. It is hoped that non-psychiatric physicians will increasingly recognize depression in their patients and feel comfortable in its evaluation and initial management. Clinical practice guidelines, which may be helpful to primary care physicians, are currently being developed. When patients seem difficult to manage or diagnose, consultation should be sought from psychiatrists familiar with the special presentations and problems of working with this population.