ABSTRACT
Psychiatric syndromes are both underappreciated and inadequately treated in medically ill patients. This is particularly true for individuals with medical problems who also suffer from chronic depression. The most prevalent medical illnesses in the United States (e.g., heart disease, cancer, cerebrovascular disease) are associated with higher rates of depressive disorders than are seen in the general population [1-4]. Increasingly, psychiatrists are being asked to evaluate and treat patients who are older, have serious medical problems, and take multiple medications, many of which cause central nervous system (CNS) adverse effects and precipitate drug-drug interactions. It is therefore not surprising that these patients present the consulting psychiatrist with multiple diagnostic and psycho-
pharmacologic challenges. This chapter is intended to provide clinicians with general principles and specific recommendations regarding the optimum diagnostic and therapeutic approaches to chronic depression in selected medical illnesses.
