Feature Article

Making sense of the complex depressed patient. Part 1: medical illness, including effects of drugs and alcohol

Feature Article

Making sense of the complex depressed patient. Part 1: medical illness, including effects of drugs and alcohol

Kay Wilhelm

Abstract

Depression takes various forms in people with medical illness including normal experience, personality traits, adjustmen reactions/disorders and clinical disorders. Differing approaches are required to treat these and enhance the patient’s ability to cope with the medical illness and other comorbidities.

Key Points

  • Depression in the context of medical illness is often viewed as being ‘understandable’ and not requiring treatment. However, the physical illness and its treatment can contribute to the precipitation of clinical depression.
  • Psychotherapy and allied health interventions (including clinical psychology, occupational therapy and physiotherapy) should be considered as well as antidepressants when managing depression in patients with medical illnesses.
  • When choosing medications, the target symptoms and the side effect profiles of the medications should be considered.
  • Dual action antidepressants, which are both serotonergic and noradrenergic, can improve depression, insomnia and pain tolerance.
  • In those patients with multiple medical, psychiatric and substance use comorbidities, ceasing substance use can assist mental as well as physical health.