Antidepressant treatment in major depressive disorder comorbid with medical illness

Medically ill subjects experience high rates of depression. This is a significant association that impacts the prognosis of both medical and psychiatric treatments. This article reviews studies comparing the outcome of antidepressant treatment in subjects with major depressive disorder (MDD) with and without comorbid medical illness. MDD subjects with medical illness tend to have lower improvement of depressive symptoms and higher rates of depressive relapse with antidepressant treatment compared to MDD subjects without medical illness. In addition, this article reviews the limited data for specific antidepressant treatment strategies for MDD subjects with medical illness. It concludes with clinical strategies recommended in light of the literature reviewed: an increased index of suspicion for depression in medically ill subjects, and more aggressive antidepressant treatment in depressed subjects with medical comorbidity.