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Depression in the medically ill: Management considerations
Author(s) -
Evans Dwight L.,
Staab Jeffrey,
Ward Herb,
Leserman Jane,
Perkins Diane O.,
Golden Robert N.,
Petitto John M.
Publication year - 1996
Publication title -
depression and anxiety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.634
H-Index - 129
eISSN - 1520-6394
pISSN - 1091-4269
DOI - 10.1002/(sici)1520-6394(1996)4:4<199::aid-da6>3.0.co;2-a
Subject(s) - medicine , anticholinergic , management of depression , tricyclic , antidepressant , coronary artery disease , depression (economics) , psychosocial , adverse effect , tricyclic antidepressant , psychiatry , intensive care medicine , pharmacology , anxiety , primary care , family medicine , economics , macroeconomics
This article reviews the management of depression in three medical conditions associated with a high frequency of depression: coronary artery disease (CAD), cancer, and human immunodeficiency virus (HIV) infection. Major depression significantly increases mortality in patients with CAD. This effect of depression may be mediated by a decrease in heart rate variability. Tricyclic antidepressants (TCAs) possess Type 1A antiarrhythmic activity, which may increase the risk of sudden death. Initial data suggest that tricyclic antidepressants also may decrease heart rate variability. Antidepressant therapy is effective and can improve quality of life for patients with cancer or HIV infection. Strong social support or psychosocial interventions that improve coping skills may positively affect outcome in HIV infection and cancer. Selective serotonin reuptake inhibitors(SSRIs) and new agents may be well suited for use in depressed patients with medical illnesses because they lack the significant adverse anticholinergic and cardiovascular effects of TCAs and other classes of antidepressants. Depression and Anxiety 4:199–208, 1996/1997.© 1997 Wiley‐Liss, Inc.