Management and Treatment of Patients With Major Depressive Disorder and Chronic Diseases: A Multidisciplinary Approach.

Susana Sousa Almeida,Ennio Lubrano,Giorgio Di Dato,Alessandro Comandini,Riccardo Torta,Francesca Benedetta Zizzi,Clelia Pellicano,Serena Tongiani,Agnese Cattaneo,Vincenza Spallone

doi:10.3389/fpsyg.2020.542444

Abstract

In patients with physical chronic diseases, the prevalence of major depressive disorder (MDD) is approximately 2‐ to 3-fold higher than in the general population, and it can reach up to 20–40%. The comorbidity of MDD with chronic medical diseases is associated with poorer quality of life, increased medical symptom burden, poor adherence to self-care regimens, increased risk of functional impairment, morbidity, and mortality, and also higher medical costs. Despite this evidence, in routine practice, psychological issues and concerns are frequently inadequately managed. This consensus document proposes that a proper diagnosis, a multidisciplinary approach, and a personalized treatment plan would allow patients with MDD and chronic comorbidities to be more compliant, to improve the outcomes, to reduce possible relapses in the long term, and to prevent or better manage complications and adverse events. This proposal might be useful for any health professionals who deal with patients with chronic diseases, as it can help to pay more attention to the emotional impact of these conditions, in particular in terms of depressive symptoms.

Highlights

The prevalence of major depressive disorder (MDD) in the general population is approximately 6.6% (Kessler et al, 2005), with a lifetime prevalence of approximately 11% (Lim et al, 2018)
A higher prevalence of MDD has been found in patients with a range of chronic conditions, including cardiovascular diseases (Rudisch and Nemeroff, 2003), diabetes (Anderson et al, 2001), arthritis (Matcham et al, 2013), and cancer (Smith, 2015)
The following terms were used in combination with a range of subject headings for each database: AND

Summary

INTRODUCTION

The prevalence of major depressive disorder (MDD) in the general population is approximately 6.6% (Kessler et al, 2005), with a lifetime prevalence of approximately 11% (Lim et al, 2018). In patients with chronic diseases, MDD prevalence is approximately 2- to 3-fold higher, notably reaching up to 20–40% (Read et al, 2017). The comorbidity of MDD with chronic diseases has been associated with poorer quality of life, increased symptom burden, poor adherence to self-care regimens, increased risk of morbidity and mortality, and higher medical costs (Moussavi et al, 2007; Katon, 2011; Reddy, 2016). MDD can worsen the outcomes of chronic diseases because of its effect on proinflammatory factors, the hypothalamicpituitary axis, the autonomic nervous system, and metabolic factors, in addition to being associated with a higher risk of engaging in health risk behaviors (Katon, 2011). As MDD has been linked to low-grade inflammation/dysregulated inflammation, in the long term such condition may predispose to the onset of a chronic disease (Miller and Raison, 2016)

MATERIALS AND METHODS

Features and methods

Findings

CONCLUSION