At the time, the authors concluded that trials of antidepressants in medical inpatients did not achieve the pattern of therapeutic responses routinely characterizing comparable interventions

in psychiatric patients with depression.34 However, there are now many studies demonstrating not only good tolerability of the newer antidepressants in the medically ill but also response and remission rates comparable to depressed patients without medical illness. This was confirmed in a Inhibitors,research,lifescience,medical recent, meta-analysis including 18 studies, covering 838 patients with a range of physical diseases (cancer 2, diabetes 1, head injury 1, heart 1, HIV 5, lung 1, multiple sclerosis 1 , renal 1 , stroke 3, mixed 2).35 The results of the meta-analysis

were corroborated by newer randomized controlled trials in patients with coronary heart disease,36-38 diabetes,39 and Inhibitors,research,lifescience,medical stroke.40 The studies above were conducted in patients who all had a medical illness. Clinical trials of antidepressants usually exclude patients with medical comorbidity. However, some studies also addressed the issue of response and remission in depressed patients with and without medical comorbidity. The STAR*D study, which was designed to reflect “real-world” conditions, confirmed that two thirds of depressed patients had at least one concurrent general medical condition.12 Inhibitors,research,lifescience,medical Generally, the remission rates in STAR*D (about 30%) were similar to rates found in uncomplicated, nonchronic symptomatic volunteers enrolled in placebo-controlled, 8-week, randomized controlled trials with selective serotonin reuptake inhibitors.7 Nevertheless, more general medical disorders were associated with lower Inhibitors,research,lifescience,medical remission scores. Furthermore, in a study with 370 depressed Inhibitors,research,lifescience,medical patients, a comorbid medical condition was one of six risk factors for sustainednonremission of depression over 4 years.41 These findings are consistent with another study in 384 depressed outpatients that were enrolled in a 8-week open treatment with fluoxetine. Compared with patients who achieved remission with antidepressant

treatment, those who did not achieve remission had significantly greater medical illness. selleck inhibitor Importantly, the final Hamilton depression rating Scale score directly correlated from with the total burden of medical illness.42 However, among those patients for whom the first antidepressant treatment with fluoxetine failed to achieve remission and who were randomized cither to increased doses of fluoxetine or to augmentation with lithium or desipramine, medical illness was not associated with likelihood of remission or premature study discontinuation.43 There also exist studies in primary care. Among 601 depressed patients treated in primary care settings with an SSRI and followed over 9 months, physical impairment was one of four independent predictors of nonresponse.