[Evidence-based recommendations for the treatment of depressive comorbidity in somatic illness].Internist (Berl) 2019; 60(12):1226-1234I
Comorbid depression is frequent in internal medicine (e.g. in coronary heart disease, congestive heart failure or diabetes mellitus) and impairs quality of life as well as the prognosis of the somatic illness.
To review evidence based recommendations for the treatment of depressive comorbidity in selected somatic disorders.
MATERIALS AND METHODS
Selective literature search based on national and international guidelines.
In clinical routine, depressive symptoms are often overseen or misinterpreted. Therefore, a specific diagnostic is recommended. Depressive symptoms should obligatory be screened during the clinical interview or by validated questionnaires. When screened positive, further diagnostic steps are mandatory. The treatment of depressive disorders has three main components: basic psychosomatic care, psychotherapy and antidepressant medication. These interventions are safe and effective for reducing depressive symptoms and enhancing quality of life. However, results regarding the effects on morbidity and mortality of the comorbid somatic disorder are still inconclusive. The greatest effects on depression are obtained by a preference-based, stepped-care approach and an optimal cooperation of all professionals ("collaborative care").
An effective treatment of depressive comorbidity is relevant for quality of life and possibly also for the prognosis of a somatic disease. Integrating a routine screening for depressive symptoms is the first step toward an effective, evidence-based therapy.