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Comorbid depression in medical diseases

Nature Reviews Disease Primers volume 6, Article number: 69 (2020) Cite this article

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Abstract

Depression is one of the most common comorbidities of many chronic medical diseases including cancer and cardiovascular, metabolic, inflammatory and neurological disorders. Indeed, the prevalence of depression in these patient groups is often substantially higher than in the general population, and depression accounts for a substantial part of the psychosocial burden of these disorders. Many factors can contribute to the occurrence of comorbid depression, such as shared genetic factors, converging biological pathways, social factors, health behaviours and psychological factors. Diagnosis of depression in patients with a medical disorder can be particularly challenging owing to symptomatic overlap. Although pharmacological and psychological treatments can be effective, adjustments may need to be made for patients with a comorbid medical disorder. In addition, symptoms or treatments of medical disorders may interfere with the treatment of depression. Conversely, symptoms of depression may decrease adherence to treatment of both disorders. Thus, comprehensive treatment plans are necessary to optimize care.

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Fig. 1: Possible heuristic models to explain the comorbid occurrence of depression and medical diseases.
Fig. 2: Prevalence estimates of comorbid MDD in patients with chronic medical diseases.
Fig. 3: Aetiopathogenesis of comorbid depression.
Fig. 4: Psychological factors involved in adjusting to chronic illness.
Fig. 5: Algorithm for diagnosing depression in patients with comorbid medical diseases.
Fig. 6: Interdisciplinary care for comorbid depression.

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Acknowledgements

S.M.G. receives funding from the Deutsche Forschungsgemeinschaft (GO1357/5-2; 8-2), the European Commission (IMI2 859366), the German Federal Ministry of Health (BMG-BVA 2520FSB431) and the National MS Society (MB-1707-28359; RG-1507-05418). J.J.M. has received support from the Alliance for Health Policy and Systems Research (HQHSR1206660), the Bernard Lown Scholars in Cardiovascular Health Program at Harvard T.H. Chan School of Public Health (BLSCHP-1902), Bloomberg Philanthropies, FONDECYT via CIENCIACTIVA/CONCYTEC, British Council, British Embassy and the Newton-Paulet Fund (223-2018, 224-2018), DFID/MRC/Wellcome Global Health Trials (MR/M007405/1), Fogarty International Center (R21TW009982, D71TW010877), Grand Challenges Canada (0335-04), Inter-American Institute for Global Change Research (IAI CRN3036), International Development Research Center Canada (IDRC 106887, 108167), Medical Research Council (MR/P008984/1, MR/P024408/1, MR/P02386X/1), National Cancer Institute (1P20CA217231), National Heart, Lung and Blood Institute (HHSN268200900033C, 5U01HL114180, 1UM1HL134590), National Institute of Mental Health (1U19MH098780), Swiss National Science Foundation (40P740-160366), Wellcome Trust (074833/Z/04/Z, 093541/Z/10/Z, 103994/Z/14/Z, 107435/Z/15/Z, 205177/Z/16/Z, 214185/Z/18/Z, 218743/Z/19/Z) and the World Diabetes Foundation (WDF15-1224). C.O. has received funding from the Deutsche Forschungsgemeinschaft (OT 209/7-3; 14-1), the European Commission (IMI2 859366) and the German Federal Ministry of Education and Research (KS2017-067). The authors thank V. Stiglbauer (Charité – Universitätsmedizin Berlin) for help with formatting of the manuscript draft.

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Authors and Affiliations

  1. Charité – Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health (BIH), Klinik für Psychiatrie und Psychotherapie, Campus Benjamin Franklin, Berlin, Germany

    Stefan M. Gold & Christian Otte

  2. Charité – Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt Universität zu Berlin, Berlin Institute of Health (BIH), Medizinische Klinik m.S. Psychosomatik, Campus Benjamin Franklin, Berlin, Germany

    Stefan M. Gold

  3. Institut für Neuroimmunologie und Multiple Sklerose (INIMS), Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany

    Stefan M. Gold

  4. Department for Affective Disorders, Aarhus University Hospital - Psychiatry, Aarhus, Denmark

    Ole Köhler-Forsberg

  5. Department of Clinical Medicine, Aarhus University, Aarhus, Denmark

    Ole Köhler-Forsberg

  6. Psychosis Research Unit, Aarhus University Hospital - Psychiatry, Aarhus, Denmark

    Ole Köhler-Forsberg

  7. Psychology Department, Institute of Psychology, Psychiatry and Neuroscience, King’s College London (KCL), Guy’s Hospital Campus, London Bridge, London, UK

    Rona Moss-Morris

  8. Abteilung für Medizinische Psychologie und Medizinische Soziologie, Universitätsklinikum Leipzig, Leipzig, Germany

    Anja Mehnert

  9. CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru

    J. Jaime Miranda

  10. Institut und Poliklinik für Medizinische Psychologie, Unversitätsklinikum Hamburg-Eppendorf, Hamburg, Germany

    Monika Bullinger

  11. Department of Behavioural Science and Health, University College London, London, UK

    Andrew Steptoe

  12. University of California, San Francisco (UCSF), San Francisco VA Health Care System, San Francisco, CA, USA

    Mary A. Whooley

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Contributions

Introduction (S.M.G. and C.O.); Epidemiology (O.K.-F. and M.A.W.); Mechanisms/pathophysiology (S.M.G., O.K.-F., R.M.-M. and A.S.); Diagnosis, screening and prevention (M.A.W. and C.O.); Management (S.M.G., O.K.-F., A.M., J.J.M. and C.O.); Quality of life (M.B.); Outlook (S.M.G.); Overview of Primer (S.M.G. and C.O.).

Corresponding author

Correspondence to Stefan M. Gold.

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Competing interests

S.M.G. reports personal fees from Almirall SA, Celgene, Forum für Medizinische Fortbildung (FomF) and Mylan GmbH, and in-kind research contributions from GAIA Group. R.M.-M. reports personal fees from Mahana Therapeutics and is a beneficiary of a license agreement between Mahana Therapeutics and King’s College London. C.O. reports personal fees from Allergan, Ferring, Fortbildungskolleg, Limes Kliniken, Medical Tribune, MedOnline, Neuraxpharm, Sage Therapeutics and Stillachhaus. All other authors declare no competing interests.

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Nature Reviews Disease Primers thanks C. Caltagirone, C. Pae, S. Patten, P. De Jonge, Y. Uchitomi and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Gold, S.M., Köhler-Forsberg, O., Moss-Morris, R. et al. Comorbid depression in medical diseases. Nat Rev Dis Primers 6, 69 (2020). https://doi.org/10.1038/s41572-020-0200-2

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