Comorbid depression in neurologic disorders

Jasper James Chen MD MPH (Dr. Chen of Cheyenne Regional Medical Center has no relevant financial relationships to disclose.)
Tracie Caller MD MPH (Dr. Caller of Dartmouth-Hitchcock Medical Center has no relevant financial relationships to disclose.)
Matthew Lorincz MD PhD, editor. (Dr. Lorincz of the University of Michigan receives salary support from Wilson Therapeutics AB for performing UWDRS examinations in a clinical trial.)
Originally released September 19, 2014; expires September 19, 2017

Overview

The extent and burden of comorbid depression is highlighted for several common neurologic conditions including stroke, Parkinson disease, Alzheimer disease, multiple sclerosis, epilepsy, and migraine. This article summarizes basic recommendations for psychopharmacologic and psychotherapeutic interventions. Regular and periodic screening for comorbid depression is recommended for individuals treated for neurologic conditions using validated, standardized instruments. The standard of care for treating comorbid depression includes timely identification and recognition of depressive symptomology, discussion and education regarding treatment options, and standardized assessment of treatment efficacy.

Key points

 

• Comorbid depression is common in patients with neurologic disease and is seen in approximately 25% of post-stroke patients and 33% of Parkinson disease, 40% of Alzheimer disease, 40% of multiple sclerosis, and 10% of patients with epilepsy in the clinical setting.

 

• Patients with neurologic disease who are at an increased risk for comorbid depression or suicide should be screened regularly using appropriate, standardized, evidence-based measures (PHQ-2, PHQ-9, HAM-D, BDI).

 

• Patients and caregivers alike should be educated about depression symptoms and offered psychopharmacologic and psychotherapeutic treatments as soon as comorbid symptoms are recognized.

 

• When prescribing any antidepressant, the general rubric is to “start low and go slow” in order to avoid adverse side effects.

 

• Due to low adverse effect profile, SSRIs are well-tolerated and preferred first-line treatments for comorbid depression in patients with neurologic disorders.

Historical note and terminology

There is increasing evidence suggesting that depression is both a cause and consequence of neurologic diseases (Raskind 2008), although biological linkages may remain undiscovered (Evans et al 2005).

Psychiatric symptoms, and depressive syndromes in particular, are frequently comorbid in myriad neurologic conditions. In particular, stroke, Parkinson disease, Alzheimer disease, multiple sclerosis, epilepsy, and migraine are among the most common neurologic disorders correlated with comorbid depression. Adding depression to the existing burden of underlying neurologic conditions increases direct and indirect costs, impairs rehabilitation, reduces quality of life, and distresses patients and caregivers (Raskind 2008).

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