Affective disorders: depression and somatic co-morbidity
This lecture provides an overview of depression (epidemiology and course of the disorder), clinical presentation, somatic co-morbidity, and treatment options. Speaker: Barbara Sperner-Unterweger.
During the past twenty years the relationship between depressive symptoms and somatic conditions such as cardiovascular disease, diabetes, cancer, and neurodegenerative disorders has received increasing attention in research. Depressive symptoms may be a secondary reaction to the development of the somatic disease, or to complications and aversive symptoms; in addition, they may also be related to side effects of medications administered to treat the illness. Aside from these indirect effects, as well as disease- specific direct pathophysiological effects on the brain (i.e. stroke, or multiple sclerosis), inflammation is the common underlying condition of these chronic somatic diseases). Thus, patients who suffer from chronic inflammatory processes due to autoimmune syndromes, infections, or
cancer, etc., have an increased risk of developing fatigue and depression. Similar clinical abnormalities can develop as side effects in patients under treatment with pro-inflammatory cytokines such as interleukins, interferons or tumor necrosis factor. Immune activation and the serotonergic system are linked by the activity of the enzyme indoleamine 2,3-dioxygenase (IDO), which is involved in the breakdown of tryptophan, the essential precursor of 5-HT. The activity of IDO is enhanced by proinflammatory cytokines.
Immunbiochemical interactions between the metabolism of serotonin but also of catecholamines might indeed account for the increased prevalence of clinical depression in chronically ill people).
- Overview of depression: epidemiology and course of the disorder
- Clinical presentation and diagnosis
- Depression and somatic co-morbidity
- Current treatments
- Future research directions