Medicus, Vol. 13 No. 1_Depresija, 2004.
Pregledni rad
Treatment of Depression in Patients with Comorbidity
Pavo Filaković
Sažetak
The treatment of depression in comorbid
patients requires therapeutic adaptation to their overall
health condition. Depression can be accompanied by other
mental and physical disorders. Anxiety disorders and addictions
are the most common mental disorders. The most frequent
somatic disorders accompanying depression are: cardiovascular
(chronic heart disease, cardiac infarction);
endocrine (hypothyreosis, hyperthyreosis, Cushing’s syndrome,
diabetes mellitus, sexual disorders); painful syndromes;
iatrogenic conditions; cancer and terminal conditions.
The unique therapeutic problem in the elderly is the
treatment of comorbidity of depression and multiple physical
disorders. Selective serotonin reuptake inhibitors (SSRIs) represent
the treatment of choice for depression accompanied
by anxiety disorders and addictions. Since SSRIs can cause a
transient deterioration of anxiety at the beginning of treatment,
the treatment should be initiated with lower doses of
antidepressants and, if necessary, anxyolitics. During the
treatment of depression with physical comorbidity, the choice
of antidepressants should be adjusted to the patient’s physical
condition. In patients with myocardial infarction, the early
diagnosis of depression and timely beginning of treatment
with SSRIs could significantly prolong life and improve its
quality. SSRIs are the first choice drugs in the treatment of
depression with diabetes. Tricyclic antidepressants are efficient
in the treatment of chronic painful syndromes accompanied
by depression. However, in the case of intolerability, the
new generation dual antidepressants are recommended.
Although a sufficient number of trials confirmed a favorable
therapeutic response to tricyclic antidepressants in physically
healthy but depressive elderly patients, they should be
given with caution due to numerous unpleasant side effects.
Today, SSRIs are considered as the drugs of first choice, and
they are the most frequently administered antidepressants in
the elderly. Depending on a type of depressive and comorbid
disorder, psychoeducation and appropriate cognitive-behavioral
therapy are also recommended.
Ključne riječi
depression; comorbidity; pharmacotherapy
Hrčak ID:
19806
URI
Datum izdavanja:
26.1.2004.
Posjeta: 4.435 *