Treatment of Depression in Medical Illness

Depression is a common and potentially deadly concomitant of many medical illnesses. While the multiple psychological stressors associated with being sick have long been recognized as a risk factor for depression, increasing data indicate that activation of the pro-inflammatory cytokine network also directly contributes to mood disturbance in the medically ill. Moreover, recent studies using treatment with the cytokine interferon-alpha-2b (IFN-alpha) as a model system for immunebased depression indicate that depression in the medically ill may represent an amalgam of mood-specific and neurovegetative symptom clusters that are mediated by different neuroendocrine/neurotransmitter pathways. These findings provide novel insights into ongoing diagnostic controversies created by the striking symptom overlap between major depression and sickness and have clear implications for the pharmacological treatment of depressive syndromes in patients with medical illnesses.