May 2012  << Back  

Managing medical and psychiatric comorbidity in individuals with major depressive disorder and bipolar disorder

Roger S. McIntyre, MD, FRCPC

Mood Disorders Psychopharmacology Unit, University Health Network, Departments of Psychiatry and Pharmacology, University of Toronto, Toronto, Ontario, Canada

Michael 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, Canada

Rajamannar Ramasubbu, MD, FRCPC, MSc

Department of Psychiatry and Clinical Neurosciences, University of Calgary, Hotchkiss Brain Institute, Calgary, Alberta, Canada

David J. Bond, MD, FRCPC

Mood Disorders Centre, University of British Columbia, Vancouver, British Columbia, Canada

Valerie H. Taylor, MD, PhD, FRCPC

Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada

Serge Beaulieu, MD, PhD, FRCPC

Douglas Mental Health University Institute, Department of Psychiatry, McGill University, Montréal, Québec, Canada

Ayal 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):163–169

CORRESPONDENCE 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 roger.mcintyre@uhn.on.ca
Annals of Clinical Psychiatry ©2012 Quadrant HealthCom Inc.

 
Read full article