Article

Managing medical and psychiatric comorbidity in individuals with major depressive disorder and bipolar disorder

Mood Disorders Psychopharmacology Unit, University Health Network, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
Annals of Clinical Psychiatry (Impact Factor: 2.36). 05/2012; 24(2):163-9.
Source: PubMed

ABSTRACT

Most individuals with mood disorders experience psychiatric and/or medical comorbidity. Available treatment guidelines for major depressive disorder (MDD) and bipolar disorder (BD) have focused on treating mood disorders in the absence of comorbidity. Treating comorbid conditions in patients with mood disorders requires sufficient decision support to inform appropriate treatment.
The Canadian Network for Mood and Anxiety Treatments (CANMAT) task force sought to prepare evidence- and consensus-based recommendations on treating comorbid conditions in patients with MDD and BD by conducting a systematic and qualitative review of extant data. The relative paucity of studies in this area often required a consensus-based approach to selecting and sequencing treatments.
Several principles emerge when managing comorbidity. They include, but are not limited to: establishing the diagnosis, risk assessment, establishing the appropriate setting for treatment, chronic disease management, concurrent or sequential treatment, and measurement-based care.
Efficacy, effectiveness, and comparative effectiveness research should emphasize treatment and management of conditions comorbid with mood disorders. Clinicians are encouraged to screen and systematically monitor for comorbid conditions in all individuals with mood disorders. The common comorbidity in mood disorders raises fundamental questions about overlapping and discrete pathoetiology.

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    • "Studies have identified psychiatric and medical comorbidities that occur at a high rate among individuals with MDD, including anxiety disorder (McIntyre et al., 2012a), attention deficit hyperactivity disorder (ADHD) (Bond et al., 2012), chronic fatigue syndrome (Dansie et al., 2012), and metabolic syndrome (Richter et al., 2010). In addition, many patients with a major depressive episode may be suffering with a bipolar mood disorder (McIntyre et al., 2012b). Not only do comorbidities contribute to disease burden and economic cost of MDD, but they also lead to poorer patient outcomes (McIntyre et al., 2012c). "
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    ABSTRACT: Although many treatments for Major Depressive Disorder (MDD) exist, only half of all patients respond to initial trial of pharmacotherapy and only a third will achieve remission with that trial. First-line therapies for the management of MDD include psychotherapy or pharmacotherapy, alone or in combination. Given the disappointing rates of response and remission to initial therapy, clinicians are looking for methods to improve the management of MDD, such as through the use of adjunct therapies. The first article in this series, by Katzman and Chokka, discusses gaps in the treatment of MDD and proposes measures to change and strengthen future practice guidelines. Epstein et al. summarize the findings of clinical studies, systematic analyses, and reviews of trials supporting the use of adjunct therapy for the treatment of MDD. Velehorschi et al. review emerging research identifying common pathophysiological processes between MDD and three of its comorbidities. Lastly, Cameron and Habert highlight the challenges that primary care physicians face in the management of MDD. Ultimately, the goal of treatment is to not only relieve symptoms of MDD, but achieve sustained remission. This supplement was written to address the issues of less than ideal outcomes and approaches to enhancing response and remission rates. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
    Full-text · Article · Dec 2014 · Psychiatry Research
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    • "with MDD commonly experience long-term negative outcomes , frequent relapses, incomplete recovery between episodes, and persistent psychosocial impairment (Greer et al., 2010). MDD is considered one of the 10 leading causes of disability affecting the global population (Lopez et al., 2006) and is associated with multiple chronic medical illnesses (McIntyre et al., 2012) and a profound disability although many psychopharmacological agents are currently available for its treatment (Serafini et al., 2013). MDD is also associated with an increased risk for suicidal behaviors (Pompili et al., 2011, 2012a, 2012b; Serafini et al., 2011, 2012, 2013; Innamorati et al., 2011). "

    Full-text · Article · Feb 2014 · Neurology Psychiatry and Brain Research
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    • "with MDD commonly experience long-term negative outcomes , frequent relapses, incomplete recovery between episodes, and persistent psychosocial impairment (Greer et al., 2010). MDD is considered one of the 10 leading causes of disability affecting the global population (Lopez et al., 2006) and is associated with multiple chronic medical illnesses (McIntyre et al., 2012) and a profound disability although many psychopharmacological agents are currently available for its treatment (Serafini et al., 2013). MDD is also associated with an increased risk for suicidal behaviors (Pompili et al., 2011, 2012a, 2012b; Serafini et al., 2011, 2012, 2013; Innamorati et al., 2011). "
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    ABSTRACT: There is growing evidence that inflammatory mediators play a critical role in the pathophysiology of both major depression and suicidal behavior. Immunological differences have been reported in both major affective disorders and suicidal behavior. Specifically, increased levels of pro-inflammatory cytokines have been shown to correlate with the severity of depression and various cytokines have been identified as potentially important in understanding the pathophysiology of major affective disorders/suicidality. We aimed to conduct a systematic review of the current literature to investigate the association between inflammatory cytokines and suicidal behavior. Only articles from peer-reviewed journals were selected for inclusion in the present review. Most studies documented the association between suicidality and IL2, IL-6, IL-8, TNF-α and VEGF levels that have been found altered in suicidal behavior. The presence of major depressive disorder (MDD) with suicidal ideation/attempts was associated with differences in inflammatory cytokine profile when compared to that without suicidal ideation/attempts. Most suicide attempters or subjects with suicidal ideation showed an imbalance of the immune system but this does not imply the existence of a causal link. Also, not all studies demonstrated a positive correlation between inflammatory cytokines and suicidal behavior. Further additional studies should elucidate the molecular mechanisms of the immune activation pathways underlying suicidality.
    Full-text · Article · Jul 2013 · European neuropsychopharmacology: the journal of the European College of Neuropsychopharmacology
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