Mood disorders in the medically ill: scientific review and recommendations.
OBJECTIVE
The purpose of this review is to assess the relationship between mood disorders and development, course, and associated morbidity and mortality of selected medical illnesses, review evidence for treatment, and determine needs in clinical practice and research.


METHODS
Data were culled from the 2002 Depression and Bipolar Support Alliance Conference proceedings and a literature review addressing prevalence, risk factors, diagnosis, and treatment. This review also considered the experience of primary and specialty care providers, policy analysts, and patient advocates. The review and recommendations reflect the expert opinion of the authors.


METHODS
Reviews of epidemiology and mechanistic studies were included, as were open-label and randomized, controlled trials on treatment of depression in patients with medical comorbidities. Data on study design, population, and results were extracted for review of evidence that includes tables of prevalence and pharmacological treatment. The effect of depression and bipolar disorder on selected medical comorbidities was assessed, and recommendations for practice, research, and policy were developed.


CONCLUSIONS
A growing body of evidence suggests that biological mechanisms underlie a bidirectional link between mood disorders and many medical illnesses. In addition, there is evidence to suggest that mood disorders affect the course of medical illnesses. Further prospective studies are warranted.
Evans
Dwight L
DL
School of Medicine, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, USA. psych@mail.med.upenn.edu
Charney
Dennis S
DS
Lewis
Lydia
L
Golden
Robert N
RN
Gorman
Jack M
JM
Krishnan
K Ranga Rama
KR
Nemeroff
Charles B
CB
Bremner
J Douglas
JD
Carney
Robert M
RM
Coyne
James C
JC
Delong
Mahlon R
MR
Frasure-Smith
Nancy
N
Glassman
Alexander H
AH
Gold
Philip W
PW
Grant
Igor
I
Gwyther
Lisa
L
Ironson
Gail
G
Johnson
Robert L
RL
Kanner
Andres M
AM
Katon
Wayne J
WJ
Kaufmann
Peter G
PG
Keefe
Francis J
FJ
Ketter
Terence
T
Laughren
Thomas P
TP
Leserman
Jane
J
Lyketsos
Constantine G
CG
McDonald
William M
WM
McEwen
Bruce S
BS
Miller
Andrew H
AH
Musselman
Dominique
D
O'Connor
Christopher
C
Petitto
John M
JM
Pollock
Bruce G
BG
Robinson
Robert G
RG
Roose
Steven P
SP
Rowland
Julia
J
Sheline
Yvette
Y
Sheps
David S
DS
Simon
Gregory
G
Spiegel
David
D
Stunkard
Albert
A
Sunderland
Trey
T
Tibbits
Paul
P
Valvo
William J
WJ
D000163:Acquired Immunodeficiency Syndrome / Q000150:complications* / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D001927:Brain Diseases / Q000150:complications* / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D002561:Cerebrovascular Disorders / Q000150:complications* / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D015897:Comorbidity; D003695:Delivery of Health Care / Q000592:standards*; D048909:Diabetes Complications / Q000150:complications* / Q000453:epidemiology / Q000378:metabolism / Q000628:therapy; D006801:Humans; D019964:Mood Disorders / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D009369:Neoplasms / Q000150:complications* / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D009765:Obesity; D010024:Osteoporosis; D010146:Pain; D017410:Practice Guidelines as Topic; D015995:Prevalence