Managing medical and psychiatric comorbidity in individuals with major depressive disorder and bipolar disorderRoger S. McIntyre, MD, FRCPC
Mood Disorders Psychopharmacology Unit, University Health Network, Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, Ontario, CanadaMichael Rosenbluth, MD, FRCPC
Toronto East General Hospital Day Treatment Program, East York, Ontario, Canada, Sunnybrook Health Sciences Centre, Department of Psychiatry, University of Toronto, Toronto, Ontario, CanadaRajamannar Ramasubbu, MD, FRCPC, MSc
Department of Psychiatry and Clinical Neurosciences, University of Calgary, Hotchkiss Brain Institute, Calgary, Alberta, CanadaDavid J. Bond, MD, FRCPC
Mood Disorders Centre, University of British Columbia, Vancouver, British Columbia, CanadaValerie H. Taylor, MD, PhD, FRCPC
Department of Psychiatry, University of Toronto, Toronto, Ontario, CanadaSerge Beaulieu, MD, PhD, FRCPC
Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montréal, Québec, CanadaAyal Schaffer, MD, FRCPC
Mood and Anxiety Disorders Program, Sunnybrook Health Sciences Centre, Department of Psychiatry, University of Toronto , Toronto, Ontario, Canada
BACKGROUND: Most individuals with mood disorders experience psychiatric and/or medical comorbidity. Available treatment guidelines for major depressive disorder (MDD) and bipolar disorder (BD) have focused on treating mood disorders in the absence of comorbidity. Treating comorbid conditions in patients with mood disorders requires sufficient decision support to inform appropriate treatment.
METHODS: The Canadian Network for Mood and Anxiety Treatments (CANMAT) task force sought to prepare evidence- and consensus-based recommendations on treating comorbid conditions in patients with MDD and BD by conducting a systematic and qualitative review of extant data. The relative paucity of studies in this area often required a consensus-based approach to selecting and sequencing treatments.
RESULTS: Several principles emerge when managing comorbidity. They include, but are not limited to: establishing the diagnosis, risk assessment, establishing the appropriate setting for treatment, chronic disease management, concurrent or sequential treatment, and measurement-based care.
CONCLUSIONS: Efficacy, effectiveness, and comparative effectiveness research should emphasize treatment and management of conditions comorbid with mood disorders. Clinicians are encouraged to screen and systematically monitor for comorbid conditions in all individuals with mood disorders. The common comorbidity in mood disorders raises fundamental questions about overlapping and discrete pathoetiology.
KEYWORDS: bipolar disorder, major depressive disorder, comorbidity, obesity, anxiety disorders, personality disorders, substance use disorders, attention-deficit/hyperactivity disorder, cardiovascular disease, hypertension, dyslipidemia
ANNALS OF CLINICAL PSYCHIATRY 2012;24(2):163–169CORRESPONDENCE Roger S. McIntyre, MD, FRCPC, Mood Disorders Psychopharmacology Unit University Health Network, Departments of Psychiatry and Pharmacology University of Toronto, 399 Bathurst Street, MP9-325, Toronto, ON, M5T 2S8 Canada E-MAIL firstname.lastname@example.orgAnnals of Clinical Psychiatry ©2012 Quadrant HealthCom Inc.