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condition, it does indicate that depression often is present in individuals with chronic conditions. Therefore, the timely diagnosis and treatment of depressive disorders are essential irrespective of causality.

Depression may be detected early when the individual presents. After initiating medications, follow-up is challenging. Diseases such as diabetes have tests such as Hemoglobin A1c to assist in disease control, but depression has no such guide in determining successful treatments and medication adherence. If the community setting treatment teams are aware of depression and how to manage this disorder, locally available and cost-effective interventions may be effective.24

The primary care physician (PCP) should be the cornerstone for the evaluation of underlying depression and referral for treatment. In many primary care settings, individuals may present with illnesses such as chronic pain, diabetes, sleep disorders, cardiovascular disease, and arthritis. In multiple disorders that include depression, the depression often remains undiagnosed. Furthermore, even if it is diagnosed, treatment usually focuses on the other chronic diseases. Depression can accompany any chronic illness.25

To summarize, major depression may co-occur with other illnesses. Such illnesses may precede the depression, cause it, and/or be a consequence of it. It is likely that the mechanics behind the intersection of depression and other illnesses differ for every person and situation. Regardless, these other co- occurring illnesses need to be diagnosed and treated.2

The results of a 1996 survey were staggering and confirmed the relationship between chronic illnesses and depression. About 50% of individuals with a psychiatric diagnosis had known medical co-morbidities, 35% harbored undiagnosed medical disorders, and an additional 20% had medical problems that may actually have caused or exacerbated their psychiatric condition.26 Obesity, hypertension, diabetes mellitus, and COPD were the most prevalent medical co- morbidities. These co-morbidities may be related to inactivity, medication side effects, an increased prevalence for smoking, increased substance abuse, and inadequate social support systems.26

Depressed patients with heart disease and with severe depressive symptoms were 2.2 times more likely than those with no or minimal symptoms to forget to take their cardiac and antidepressant medicines, intentionally skip them, or not take them as prescribed.27

Treating Patients with Depression and Other Illnesses

Healthcare professionals work with many patients with major depression and other illnesses. Individuals who have depression in addition to another serious medical illness tend to have more severe symptoms of both depression and the medical illness, more difficulty adapting to their medical condition,




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