Examining Comorbidities in Patients With Depression

W. Clay Jackson, MD, DipTh, discusses comorbidities in patients with depression, after his Psych Congress 2019 presentation "Clinical Challenges in MDD: Addressing the Needs of Patients with Comorbid Disorders" with Psych Congress cochairs Rakesh Jain, MD, MPH, and Charles Raison, MD. 

Dr. Jackson is a Clinical Assistant Professor of Family Medicine and Psychiatry at the University of Tennessee College of Medicine in Memphis, maintains a private practice in family medicine, and directs the palliative medicine program at the West Cancer Center in Arlington, Tennessee.


We're often attuned in psychiatry to look for the psychiatric comorbidities for patients who have major depressive disorder, MDD, such as generalized anxiety disorder, or anxious symptoms.

We know, for instance, if patients have anxious symptoms, that they're much more likely to not have a therapeutic response to antidepressant treatment, that they may have earlier relapse if they do achieve response or remission. So, we're looking for those types of things with respect to psychiatric disorders in patients with MDD.

We shouldn't forget that patients with MDD often have many comorbid medical disorders as well, such as metabolic syndrome, cardiovascular disease, and these illnesses can compound treatment with respect to treatment choice. In addition, if depression is not adequately treated, depression can impact those diseases such as diabetes.

There have been studies that have shown, for instance, of patients who have a chronic illness, such as type 2 diabetes mellitus, that those patients who have a comorbid, serious mental illness, such as a major depressive disorder, might suffer twice the healthcare utilization because of poor outcomes. This can mitigate against top-quality outcomes. It can also cause increased cost for the healthcare system.

In our presentation, Drs. [Rakesh] Jain and [Charles] Raison and myself actually examined a very interesting comorbid disorder that's common in patients with MDD, and that's substance use disorder, or alcohol use disorder.

Unfortunately, of patients who have MDD, about 40 percent of them meet the criteria for alcohol use disorder across the lifespan. This is about twice the general population average.

It's also quite common for patients, on the other hand, who have a substance use disorder to have a mood disorder. Of those who have a substance use disorder, about 20 percent have at least one mental health illness.

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