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Incomplete remission in depression: role of psychiatric and somatic comorbidity

By Christian Otte


Depression is one of the most pressing public health issues, because of its high lifetime prevalence and because it is associated with substantial disability. In depressed patients, psychiatric and medical comorbidity is the rule rather than the exception. About 60% to 70% of depressed patients have at least one, while 30% to 40% have two or more, concurrent psychiatric disorders. Among these, anxiety disorders and substance use disorders are the most common axis I comorbidities. Furthermore, two thirds of depressed patients have at least one comorbid medical illness. Among depressed patients, those with a current comorbid psychiatric condition (in particular an anxiety or substance use disorder) or medical illness seem to have an impaired response and remission rate during treatment compared with those patients without comorbidity. However, in depressed patients who all have the same comorbid condition, the relative benefit of an antidepressant compared with placebo appears to be equal to those effects achieved in depressed patients without comorbidity. These findings raise important research and treatment issues regarding the generalizability from randomized controlled trials that tend to exclude patients with comorbidity

Topics: Clinical Research
Publisher: Les Laboratoires Servier
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Provided by: PubMed Central

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  1. A meta-analysis of eight randomized, double-blind, controlled clinical trials of mirtazapine for the treatment of patients with major depression and symptoms of anxiety.
  2. (1998). A meta-analysis of the effects of venlafaxine on anxiety associated with depression.
  3. (1998). A prospective 12-year study of subsyndromal and syndromal depressive symptoms in unipolar major depressive disorders. Arch Gen Psychiatry.
  4. and future directions for defining optimal treatment outcome in depression: remission and beyond.
  5. Antidepressant use in elderly medical inpatients: lessons from an attempted clinical trial.
  6. (2000). Antidepressants for depression in medical illness. Cochrane Database Syst Rev.
  7. (1998). Anxiety as a predictor of response to interpersonal psychotherapy for recurrent major depression: An exploratory investigation. Depression Anxiety.
  8. (1993). Anxious and nonanxious depression.
  9. Anxious depression in elderly patients. Response to antidepressant treatment.
  10. Are subjects in pharmacological treatment trials of depression representative of patients in routine clinical practice?
  11. (2003). Axis III disorders in treatment-resistant major depressive disorder. Psychiatry Research.
  12. Bupropion SR in the naturalistic treatment of elderly patients with major depression.
  13. chronic diseases, and decrements in health: results from the World Health Surveys.
  14. Comorbid alcohol and substance abuse dependence in depression: impact on the outcome of antidepressant treatment.
  15. Comorbidity and depression treatment.
  16. Current comorbidity of psychiatric disorders among DSM-IV major depressive disorder patients in psychiatric care in the Vantaa Depression Study.
  17. Depression and cardiovascular disease: healing the broken-hearted.
  18. (2008). Depressive typologies and response to amitriptyline. Br
  19. Difference in treatment outcome in outpatients with anxious versus nonanxious depression: A STAR*D report.
  20. (1999). Does a coexisting anxiety disorder predict persistence of depressive illness in primary care patients with major depression? Gen Hosp Psychiatry.
  21. Effect of concurrent anxiety on response to sertraline and imipramine in patients with chronic depression. Depress Anxiety.
  22. Effect of medical comorbidity on response to fluoxetine augmentation or dose increase in outpatients with treatment-resistant depression.
  23. Effects of citalopram and interpersonal psychotherapy on depression in patients with coronary artery disease: The Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy (CREATE)
  24. Effects of treating depression and low perceived social support on clinical events after myocardial infarction: the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Randomized Trial.
  25. (2005). Epidemiology of major depressive disorder: results from the national epidemiologic survey on alcoholism and related conditions. Arch Gen Psychiatry.
  26. Escitalopram and problem-solving therapy for prevention of poststroke depression: a randomized controlled trial.
  27. Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice.
  28. Factors associated with incomplete recovery in primary depressive illness.
  29. Follow-up and family study of anxious depression.
  30. Generalizability of clinical trial results for major depression to community samples. J Clin Psychiatry. 2008:Jun 10:e1-e5. [Epub ahead of print].
  31. (1996). Impact of physical illness on quality of life and antidepressant response in geriatric major depression. Fluoxetine Collaborative Study Group.
  32. Improving the care for depression in patients with comorbid medical illness.
  33. Long-term outcome of major depressive disorder in psychiatric patients is variable.
  34. Maintenance treatment of major depression in old age.
  35. Major depressive disorder and axis I diagnostic comorbidity.
  36. (1997). Major depressive subtypes and treatment response. Biol Psychiatry.
  37. Multiple recurrences of major depressive disorder.
  38. Obesity among outpatients with Major Depressive Disorder.
  39. (2007). Overweight and obesity affect treatment response in major depression. Biol Psychiatry.
  40. partial response, and nonresponse in primary care treatment of depression.
  41. (1996). Patients excluded from an antidepressant efficacy trial.
  42. Placebo response in studies of major depression: variable, substantial, and growing.
  43. placebo, and tricyclic antidepressants in major depression with and without anxious features.
  44. Population-based Study of first onset and chronicity in major depressive disorder. Arch Gen Psychiatry.
  45. (2002). Projections of global mortality and burden of disease from
  46. Relevance of exclusion criteria in antidepressant clinical trials: a replication study.
  47. (1998). Risk factors for sustained nonremission of depressive symptoms: a 4-year follow-up. J Nerv Ment Dis.
  48. (2006). Sertraline for prevention of depression recurrence in diabetes mellitus: a randomized, double-blind, placebo-controlled trial. Arch Gen Psychiatry.
  49. Sertraline treatment of major depression in patients with acute MI or unstable angina.
  50. Severity and comorbidity predict episode duration and recurrence of DSM-IV major depressive disorder.
  51. STAR*D: what have we learned?
  52. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R).
  53. The impact of medical comorbidity on acute treatment in major depressive disorder.
  54. (1985). The outcome of antidepressant use in the medically ill. Arch Gen Psychiatry.
  55. The safety and tolerability of duloxetine in depressed elderly patients with and without medical comorbidity.
  56. Treating depression in the medically ill.
  57. Treatment of depression in patients with alcohol or other drug dependence: a meta-analysis.
  58. (1996). Treatment outcomes for primary care patients with major depression and lifetime anxiety disorders.