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Comorbidities in MDD

CME

Comorbidity Considerations in Major Depressive Disorder and Treatment Augmentation

Physicians: Maximum of 1.00 AMA PRA Category 1 Credit™

Released: April 13, 2020

Expiration: April 12, 2021

CME/CE Information

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A Call to Action

In summary, there is a strong interrelationship between MDD and physical as well as psychiatric comorbidities, including cardiovascular risk factors and substance use disorders. These relationships are complex and multidirectional, requiring integration of complex and multimodal treatments. Psychiatric and physical comorbidities are common in individuals with MDD, and MDD is common in individuals with chronic physical diseases and conditions.

To achieve optimal outcomes, mental health professionals, including psychiatrists and other health providers, must consider and address comorbidities in patients with MDD. Because approximately 70% of all antidepressants are prescribed by nonspecialists,50 including family medicine doctors and general practitioners, awareness of the interrelationship between MDD and inflammation, as well as cardiovascular risk factors and substance abuse, are crucial to improve patient outcomes. This is especially true for patients who do not respond to monotherapy with an antidepressant. Treatment augmentation requires careful therapeutic choices in people with MDD who commonly have comorbidities. Clinicians should cautiously avoid iatrogenic worsening of physical health, preferring psychotropic medications with the lowest adverse event risk potential, whether using antidepressants alone or in combination with approved second‑generation antipsychotics.

As clinicians, we should not accept that poor physical health is part of poor mental health. It is our responsibility to address comorbidities in patients with MDD; we should not leave it to be addressed solely by practitioners from other disciplines. Although individuals with MDD frequently have a lot of physical comorbidities that are typically managed by physical health specialists, mental health professionals should at least be able to educate our patients about the interrelationship between depression and poor physical health behaviors, including sedentary lifestyle, poor diet, smoking, and substance use.

We should also monitor patients for cardiovascular risk factors and be able to prescribe medications that have the lowest potential for worsening physical health. When these strategies are insufficient, we should refer patients to physical health specialists, especially when cardiovascular risk factors have evolved into illnesses such as diabetes, hypertension, or obesity. Coordinated care between psychiatric and physical health practitioners is integral to improving overall outcomes.

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In your practice, when managing patients with MDD, how likely are you to address smoking cessation and substance use disorder?
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