ABSTRACT
This chapter discusses the indications, contraindications, and clinical use of pharmacotherapy and electroconvulsive therapy (ECT) for depression in the medically ill. It details the indications and use of polycyclic antidepressants. Outcome studies of the use of these drugs for depression in the medically ill are reviewed. The chapter discusses guidelines for the use of other somatic therapies including psychostimulants, monamine oxidase inhibitors, electroconvulsive therapy, and lithium. Emphasis is placed on interventions in the medically ill patient and on the interaction and influence of these medications with medical illness and its treatment. Polycyclic antidepressants remain the mainstay of biological treatment approaches for many patients with depression. Somatic treatments, including polycyclic antidepressants, psychostimulants, lithium, and electroconvulsive therapy, may be indicated for medically ill patients with major depressive disorder. However, research is indicated to establish the treatment of first choice and the efficacy of interventions for depressed medical patients.
