title: Managing medical and psychiatric comorbidity in individuals with major depressive disorder and bipolar disorder.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Mood Disorders Psychopharmacology Unit, University Health Network, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada. roger.mcintyre@uhn.on.ca
authors.forename: Roger S
authors.initials: RS
authors.lastname: McIntyre
authors.forename: Michael
authors.initials: M
authors.lastname: Rosenbluth
authors.forename: Rajamannar
authors.initials: R
authors.lastname: Ramasubbu
authors.forename: David J
authors.initials: DJ
authors.lastname: Bond
authors.forename: Valerie H
authors.initials: VH
authors.lastname: Taylor
authors.forename: Serge
authors.initials: S
authors.lastname: Beaulieu
authors.forename: Ayal
authors.initials: A
authors.lastname: Schaffer
mesh_terms: D001714:Bipolar Disorder / Q000150:complications / Q000628:therapy*; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000150:complications / Q000628:therapy*; D019317:Evidence-Based Medicine; D006801:Humans