Treating Depression in the Medically Ill: These Patients Are Sensitive to Side Effects, May Be Taking Drugs That Can Interact with Antidepressants

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Depression and medical illness are frequent fellow travelers. Not only is the mood disorder more prevalent among people with chronic medical conditions than it is in the general population, but comorbidity complicates treatment, worsens response to antidepressants, and makes relapse more likely.

"Some patients are undertreated; others overtreated," said Steven L. Dubovsky, M.D., professor and chair of the department of psychiatry, State University of New York at Buffalo. Many illnesses produce depressionlike symptoms--low energy, loss of interest, sleep disturbance, depressed mood--that may resolve with appropriate medical treatment alone.

A focus on specifics may clarify the situation. "Distinguish hopelessness from resignation. A person with a terminal illness may be resigned but still hopeful of accomplishing important goals," Dr. Dubovsky said. Weakness is not anhedonia; even a sick person can respond positively to interactions with other people.

It is perhaps more common to discount true depressive symptoms on the …