Major depressive disorder: how to evaluate and manage patients with psychiatric and medical comorbidities

Sheng-Min Wang and Chi-Un Pae


Psychiatric and medical comorbidities occur at a high rate among patients with major depressive disorder (MDD). Both psychiatric and medical comorbidities cause worse outcomes in the treatment of MDD, and they can also lead to more complex disease presentations. Significant symptomatic overlap between MDD with psychiatric and medical conditions generates challenges to correct recognition and treatment of these so-called ‘complex’ patients in primary care (Smith et al., 2014).

Depression affects approximately 10% of primary care patients. However, MDD frequently goes under-recognized, and evidences suggest that it is recognized in only half of these patients in primary care settings (Cepoiu et al., 2008). Chronic medical conditions are observed in over 50% of depressed patients, and their presence can impede the recognition of depression by primary care providers. Thus, a collaborative care plan can significantly reduce MDD and MDD-related comorbid conditions. The influence of psychiatric and medical comorbidities in evaluation and management of MDD in primary care has increasingly become a topic of main research and clinical interest. In this chapter, we summarize existing evidence on diagnosis and treatment of MDD and co-occurring somatic and mental health conditions in primary care settings (Katon et al., 2010).

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