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Epidemiology and treatment of depression in patients with chronic medical illness Translated title: Epidemiología y tratamiento de la depresión en pacientes con una enfermedad médica crónica Translated title: Épidémiologie et traitement de la dépression chez les patients ayant une pathologie chronique

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      Abstract

      There is a bidirectional relationship between depression and chronic medical disorders. The adverse health risk behaviors and psychobiological changes associated with depression increase the risk for chronic medical disorders, and biological changes and complications associated with chronic medical disorders may precipitate depressive episodes. Comorbid depression is associated with increased medical symptom burden, functional impairment, medical costs, poor adherence to self-care regimens, and increased risk of morbidity and mortality in patients with chronic medical disorders. Depression may worsen the course of medical disorders because of its effect on proinflammatory factors, hypothalamic-pituitary axis, autonomic nervous system, and metabolic factors, in addition to being associated with a higher risk of obesity, sedentary lifestyle, smoking, and poor adherence to medical regimens. Both evidence-based psychotherapies and antidepressant medication are efficacious treatments for depression. Collaborative depression care has been shown to be an effective way to deliver these treatments to large primary care populations with depression and chronic medical illness.

      Translated abstract

      Hay una relación bidireccional entre la depresión y los trastornos médicos crónicos. Las conductas de riesgo adversas para la salud y los cambios psicobiológicos asociados con la depresión aumentan el riesgo de trastornos médicos crónicos, y los cambios biológicos y las complicaciones asociadas con los trastornos médicos crónicos pueden precipitar episodios depresivos. La depresión comórbida está asociada con un aumento de las repercusiones de los síntomas médicos, del deterioro funcional, de los costos médicos, de una pobre adherencia a los regímenes de auto-cuidado, y un mayor riesgo de morbilidad y mortal idad en los pacientes con trastornos médicos crónicos. La depresión puede empeorar la evolución de los trastornos médicos debido a su efecto sobre los factores proinflamatorios, en el eje hipotálamo-hipofisiario, en el sistema nervioso autónomo y sobre los factores metabólicos, además de estar asociada con un mayor riesgo de obesidad, de un estilo de vida sedentario, de tabaquismo y de una pobre adherencia a los tratamientos médicos. Tanto las psicoterapias basadas en la evidencia como los fármacos antidepresivos son tratamientos eficaces para la depresión. Los modelos de atención en salud de tipo colaborativo aplicados a la depresión han demostrado ser una forma efectiva para entregar estos tratamientos a grandes poblaciones de pacientes en atención primaria con depresión y enfermedades médicas crónicas.

      Translated abstract

      La dépression et les pathologies chroniques sont liées à double titre. Les comportements à risque délétères pour la santé et les modifications psychobiologiques associés à la dépression augmentent le risque de pathologies chroniques, tandis que les complications et modifications biologiques associées aux pathologies chroniques peuvent précipiter des épisodes dépressifs. La dépression, chez les patients présentant des pathologies chroniques, est associée à une augmentation de la charge symptomatique, à une détérioration fonctionnelle, à des coûts médicaux, à une mauvaise observance de l'autosurveillance et à une augmentation du risque de morbidité et de mortalité.. Elle peut aggraver le cours des maladies à cause de ses effets sur les facteurs pro-inflammatoires, sur l'axe hypothalamohypophysaire, sur le système nerveux autonome et sur les facteurs métaboliques, avec en plus un risque majoré d'obésité, de vie sédentaire, de tabagisme et de mauvaise observance des traitements médicaux. Les psychothérapies validées et les antidépresseurs sont deux approches utiles pour traiter la dépression. La prise en charge de la dépression de manière collaborative est efficace pour soigner un grand nombre de patients traités en soins primaires atteints de dépression comorbide de pathologies chroniques.

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      Most cited references 149

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        Major depression occurs in 4.4% to 20% of the general population. Studies suggest that major depression is accompanied by immune dysregulation and activation of the inflammatory response system (IRS). Our objective was to quantitatively summarize the data on concentrations of specific cytokines in patients diagnosed with a major depressive episode and controls. We performed a meta-analysis of studies measuring cytokine concentration in patients with major depression, with a database search of the English literature (to August 2009) and a manual search of references. Twenty-four studies involving unstimulated measurements of cytokines in patients meeting DSM criteria for major depression were included in the meta-analysis; 13 for tumor necrosis factor (TNF)-alpha, 9 for interleukin (IL)-1beta, 16 for IL-6, 5 for IL-4, 5 for IL-2, 4 for IL-8, 6 for IL-10, and 4 for interferon (IFN)-gamma. There were significantly higher concentrations of TNF-alpha (p < .00001), weighted mean difference (WMD) (95% confidence interval) 3.97 pg/mL (2.24 to 5.71), in depressed subjects compared with control subjects (438 depressed/350 nondepressed). Also, IL-6 concentrations were significantly higher (p < .00001) in depressed subjects compared with control subjects (492 depressed/400 nondepressed) with an overall WMD of 1.78 pg/mL (1.23 to 2.33). There were no significant differences among depressed and nondepressed subjects for the other cytokines studied. This meta-analysis reports significantly higher concentrations of the proinflammatory cytokines TNF-alpha and IL-6 in depressed subjects compared with control subjects. While both positive and negative results have been reported in individual studies, this meta-analytic result strengthens evidence that depression is accompanied by activation of the IRS. Copyright 2010 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
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          Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence.

          Depression and anxiety are common in medical patients and are associated with diminished health status and increased health care utilization. This article presents a quantitative review and synthesis of studies correlating medical patients' treatment noncompliance with their anxiety and depression. Research on patient adherence catalogued on MEDLINE and PsychLit from January 1, 1968, through March 31, 1998, was examined, and studies were included in this review if they measured patient compliance and depression or anxiety (with n>10); involved a medical regimen recommended by a nonpsychiatrist physician to a patient not being treated for anxiety, depression, or a psychiatric illness; and measured the relationship between patient compliance and patient anxiety and/or depression (or provided data to calculate it). Twelve articles about depression and 13 about anxiety met the inclusion criteria. The associations between anxiety and noncompliance were variable, and their averages were small and nonsignificant. The relationship between depression and noncompliance, however, was substantial and significant, with an odds ratio of 3.03 (95% confidence interval, 1.96-4.89). Compared with nondepressed patients, the odds are 3 times greater that depressed patients will be noncompliant with medical treatment recommendations. Recommendations for future research include attention to causal inferences and exploration of mechanisms to explain the effects. Evidence of strong covariation of depression and medical noncompliance suggests the importance of recognizing depression as a risk factor for poor outcomes among patients who might not be adhering to medical advice.
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            Author and article information

            Affiliations
            Professor and Vice-Chair, Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
            Author notes
            [* ] To whom correspondence should be addressed. E-mail: wkaton@ 123456u.wash ington.edu
            Contributors
            Professor and Vice-Chair, Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA
            Journal
            Dialogues Clin Neurosci
            Dialogues Clin Neurosci
            Dialogues in Clinical Neuroscience
            Les Laboratoires Servier (France )
            1294-8322
            1958-5969
            March 2011
            : 13
            : 1
            : 7-23
            3181964
            21485743
            Copyright: © 2011 LLS

            This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by-nc-nd/3.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

            Categories
            State of the Art

            Neurosciences

            diabetes, chronic medical illness, heart disease, depression

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