EVALUATION FOR CAUSE or CO-MORBID
CONDITIONS
The
medical evaluation of depression is critical and must not be omitted.
(further discussion below)
The
main focus is twofold:
1) To
look for medical conditions that would precipitate
or mimic depression.
2) Diagnose
and treat co-morbid conditions that would
impair the patient’s
ability
to respond to treatment
WHAT
ARE WE LOOKING FOR ?
a) Medical conditions
b) Medications
c) Disabilities
A) MEDICAL CONDITIONS
This
list is provided as an exhaustive list. A
great many of these are quickly eliminated in the History and Physical.
It is provided simply as a reference for the HCP to review.
The more common causes or comorbid conditions are indicated with
*.
| Metabolic
|
Neoplasms |
Autoimmune
diseases
|
| Vitamin
B 12 deficiency*
|
breast,
ovary, kidney, lung, pancreas
|
PMR
(polymyalgia rheumatica)*
|
| Folate
deficiency
|
leukemia/lymphoma
|
R.A
|
| Malnutrition*
|
Cerebrovascular
disease |
Sjorgren’s
synd.
|
| Endocrine
|
Lacunar
infarct* |
Temporal
arteritis
|
| Corticosteroid
withdrawal*
|
Thrombotic/hemorrhagic
stroke*
|
Neurologic
disorders |
| DM
poor control*
|
Vasculitis
|
Alzheimer’s
dz* |
| Cushings
|
Vascular
dementing syndromes*
|
A.L.S
|
| Hyper
parathyroid*
|
Infectious
disease |
Huntington’s
dz
|
| Hypothyroid*
|
Syphilis
|
Parkinson’s
dz.*
|
| Viral
infections
|
T.B.
|
Parkinson’s
Plus syndromes
|
| Hepatitis
|
Cardiac
disease |
Partial
complex seizures
|
| HIV
|
CHF*
|
Multiple
Sclerosis
|
| Infectious
Mono
|
Respiratory
disease
|
Toxins
|
| Influenza
|
COPD*
|
ALCOHOL*
|
| |
Sleep
apnea*
|
Heavy
metals
|
| |
|
Anticholinesterase
insecticides
|
| |
|
Cocaine
and amphetamine withdrawal
|
B)
MEDICATIONS
|
In general suspect either: |
a) lipophilic drugs
b)
sedative-hypnotics |
|
Antihypertensives
|
Anti-psychotics
|
H-2
Blockers
|
|
Reserpine
|
Phenothiazines
|
Cimetidine
|
|
Methyldopa
|
Cardio-vascular
|
Ranitidine
|
|
Clonidine
|
Diuretics
|
Immunosuppresives
|
|
Hydralazine
|
Digoxin
|
Vincristine
|
|
Anti-anxiety/sedative-hypnotics
|
B-Blockers
|
Narcotics
|
|
Benzodiazepines
|
Corticosteroids
|
NSAID’s
|
|
Antiparkinsonian |
Hormones |
Indomethacin
|
|
Amantadine
|
Estrogen,
Tamoxifen
|
|
|
Levodopa-carbidopa
|
Progesterone
|
|
C) DISABILITIES
A
patients’ ability to respond to antidepressant treatment is affected by their
disabilities.
Impairments
in vision and hearing should be sought and maximized.
Disabilities
of movement (e.g. arthritis, CVA’s residual etc), nutrition and chemical
dependency also impair recovery from depression.