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Feature Article

Dealing with depression and medical illness

PARAN NADESWARAN, CHRISTOPHER J. RYAN
OPEN ACCESS

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Abstract

Many physical illnesses are associated with depression, and GPs regularly encounter people with medical illnesses who also have depression. GPs can efficiently and effectively lead the management of these patients.

Key Points

  • GPs can conduct efficient and effective assessments of depressive symptoms in people with medical illnesses in primary care settings.
  • Depression can exacerbate symptoms of medical illnesses and medical illness can exacerbate depressive symptoms.
  • Some commonly used medications for conditions such as heart disease, airways disease and cancer are associated with symptoms of depression.
  • GPs are best placed to manage care for most individuals with depression, but should always refer to a psychiatrist when in doubt.

Depression profoundly affects the presentation and management of medical illness. It reduces patients’ adherence to medical treatment and their quality of life, and increases rates of hospitalisation and mortality.1 Recognition and appropriate management of the depression is key but can be challenging. The overlap between symptoms of depression and many physical illnesses can complicate the diagnosis, and treatment for one condition can sometimes exacerbate the other. 

Despite these issues, efficient assessment and treatment of depression in people with medical illnesses is achievable in general practice. The GP often has a rapport with the patient and the knowledge of their psychological, social and cultural history that is integral to managing the illness. Although the assessment process and treatment plan will depend on each patient’s unique presentation, there are a number of elements common to effective management for patients with medical illness and depressive symptoms.

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Why is depression more common in people with medical illness?

The relation between depression and medical illness is complex (Figure). Biological factors contribute to the development of depressive symptoms in people with medical illnesses, but their relative contribution varies and is difficult to quantify. The effects of chronic inflammation, changes in the parasympathetic and sympathetic nervous systems and disturbances in the hypothalamo-pituitary axis are all considered relevant.2 Abnormalities such as high concentrations of proinflammatory cytokines have been noted in studies of people with depressive symptoms, but there is considerable heterogeneity in the literature.3,4

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© FERGUS COYLE/STOCK.ADOBE.COM MODEL USED FOR ILLUSTRATIVE PURPOSES ONLY
© FERGUS COYLE/STOCK.ADOBE.COM MODEL USED FOR ILLUSTRATIVE PURPOSES ONLY
Dr Nadeswaran is an Advanced Trainee in Consultation-Liaison Psychiatry at the St John of God Richmond Hospital, Sydney. Dr Ryan is a Clinical Associate Professor and Consultation-Liaison Psychiatrist in the Discipline of Psychiatry and Sydney Health Ethics at The University of Sydney; and Director of Consultation-Liaison Psychiatry at Westmead Hospital, Sydney, NSW.