Multidisciplinary Management of Depression in Patients with Chronic Illness: Integrating Psychological, Nutritional, Nursing, and Digital Health Approaches
Abstract
Background: Major Depressive Disorder (MDD) is a highly prevalent condition that frequently co-occurs with chronic medical illnesses, creating a synergistic burden that worsens quality of life, impairs treatment adherence, and increases mortality. The relationship is bidirectional, with medical illness increasing depression risk and depression contributing to the onset and progression of somatic disease.
Aim: This article aims to review the multidisciplinary management of depression in medically ill patients, integrating psychological, pharmacological, nursing, social, and digital health approaches to improve detection and treatment outcomes.
Methods: The review synthesizes epidemiological data, pathophysiological mechanisms (including shared genetics, inflammation, and neurobiological pathways), and evidence from clinical trials and meta-analyses. It evaluates diagnostic challenges, screening tools, and a range of management strategies, including pharmacotherapy (with attention to drug-disease interactions), psychotherapy, neuromodulation, and collaborative care models.
Results: Depression is prevalent across chronic conditions like cancer, cardiovascular disease, and diabetes, with rates often exceeding 20%. Effective management requires an integrated, etiology-driven approach. Antidepressants and adapted psychotherapies demonstrate efficacy, but success depends on careful agent selection to avoid adverse interactions. Collaborative care models, which systematize screening and combine a care manager with psychiatric oversight, consistently yield the best functional and symptomatic outcomes.
Conclusion: A multifaceted, patient-centered strategy that coordinates medical and mental healthcare is essential. Success hinges on moving beyond simple screening to embed management within a structured, multidisciplinary framework that addresses the complex biological, psychological, and social interplay between depression and physical illness.
Full text article
References
Otte, C. et al. Major depressive disorder. Nat. Rev. Dis. Prim. 2, 16065 (2016).
Whiteford, H. A. et al. Global burden of disease attributable to mental and substance use disorders: findings from the global burden of disease study 2010. Lancet 382, 1575–1586 (2013).
Moussavi, S. et al. Depression, chronic diseases, and decrements in health: results from the world health surveys. Lancet 370, 851–858 (2007).
Puyat, J. H., Kazanjian, A., Wong, H. & Goldner, E. Comorbid chronic general health conditions and depression care: a population-based analysis. Psychiatr. Serv. 68, 907–915 (2017).
Gonzalez, J. S. et al. Depression and diabetes treatment nonadherence: a meta-analysis. Diabetes Care 31, 2398–2403 (2008).
Pelletier, G., Verhoef, M. J., Khatri, N. & Hagen, N. Quality of life in brain tumor patients: the relative contributions of depression, fatigue, emotional distress, and existential issues. J. Neurooncol. 57, 41–49 (2002).
Suppli, N. P. et al. Survival after early-stage breast cancer of women previously treated for depression: a nationwide Danish cohort study. J. Clin. Oncol. 35, 334–342 (2017).
Rutledge, T., Reis, V. A., Linke, S. E., Greenberg, B. H. & Mills, P. J. Depression in heart failure. J. Am. Coll. Cardiol. 48, 1527–1537 (2006).
Koyanagi, A. et al. Mortality in unipolar depression preceding and following chronic somatic diseases. Acta Psychiatr. Scand. 138, 500–508 (2018).
Cai, W., Mueller, C., Li, Y.-J., Shen, W.-D. & Stewart, R. Post stroke depression and risk of stroke recurrence and mortality: a systematic review and meta-
Momen, N. C. et al. Association between mental disorders and subsequent medical conditions. N. Engl. J. Med. 382, 1721–1731 (2020).
Plana-Ripoll, O. et al. A comprehensive analysis of mortality-related health metrics associated with mental disorders: a nationwide, register-based cohort study. Lancet 394, 1827–1835 (2019).
Plana-Ripoll, O. et al. Changes over time in the differential mortality gap in individuals with mental disorders. JAMA Psychiatry 77, 648–650 (2020).
Machado, M. O. et al. The association of depression and all-cause and cause-specific mortality: an umbrella review of systematic reviews and meta-analyses. BMC Med. 16, 112 (2018).
Roest, A. M. & de Jonge, P. The heart of the matter: in search of causal effects of depression on somatic diseases. BMC Med. 16, 147 (2018).
Ferrari, A. J. et al. Global variation in the prevalence and incidence of major depressive disorder: a systematic review of the epidemiological literature. Psychol. Med. 43, 471–481 (2013).
Vos, T. et al. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 390, 1211–1259 (2017).
Pedersen, C. B. et al. A comprehensive nationwide study of the incidence rate and lifetime risk for treated mental disorders. JAMA Psychiatry 71, 573–581 (2014).
Salk, R. H., Hyde, J. S. & Abramson, L. Y. Gender differences in depression in representative national samples: meta-analyses of diagnoses and symptoms. Psychol. Bull. 143, 783–822 (2017).
Luppa, M. et al. Age- and gender-specific prevalence of depression in latest-life – systematic review and meta-analysis. J. Affect. Disord. 136, 212–221 (2012).
Sjöberg, L. et al. Prevalence of depression: comparisons of different depression definitions in population-based samples of older adults. J. Affect. Disord. 221, 123–131 (2017).
Walker, J. et al. The prevalence of depression in general hospital inpatients: a systematic review and meta-analysis of interview-based studies. Psychol. Med. 48, 2285–2298 (2018).
Wang, J. et al. Prevalence of depression and depressive symptoms among outpatients: a systematic review and meta-analysis. BMJ Open 7, e017173 (2017).
Mitchell, A. J. et al. Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. Lancet Oncol. 12, 160–174 (2011).
Krebber, A. M. H. et al. Prevalence of depression in cancer patients: a meta-analysis of diagnostic interviews and self-report instruments. Psychooncology 23, 121–130 (2013).
Watts, S. et al. Depression and anxiety in prostate cancer: a systematic review and meta-analysis of prevalence rates. BMJ Open 4, e003901 (2014).
Watts, S., Prescott, P., Mason, J., McLeod, N. & Lewith, G. Depression and anxiety in ovarian cancer: a systematic review and meta-analysis of prevalence rates. BMJ Open 5, e007618 (2015).
Huang, J. et al. Association between depression and brain tumor: a systematic review and meta-analysis. Oncotarget 8, 94932–94943 (2017).
Mehnert, A. et al. Four-week prevalence of mental disorders in patients with cancer across major tumor entities. J. Clin. Oncol. 32, 3540–3546 (2014).
Secinti, E., Thompson, E. J., Richards, M. & Gaysina, D. Research review: childhood chronic physical illness and adult emotional health – a systematic review and meta-analysis. J. Child. Psychol. Psychiatry 58, 753–769 (2017).
Freedland, K. E. et al. Prevalence of depression in hospitalized patients with congestive heart failure. Psychosom. Med. 65, 119–128 (2003).
Brostow, D. P., Petrik, M. L., Starosta, A. J. & Waldo, S. W. Depression in patients with peripheral arterial disease: a systematic review. Eur. J. Cardiovasc. Nurs. 16, 181–193 (2017).
Feng, L. et al. Prevalence of depression in myocardial infarction. Medicine 98, e14596 (2019).
Doyle, F. et al. Systematic review and individual patient data meta-analysis of sex differences in depression and prognosis in persons with myocardial infarction. Psychosom. Med. 77, 419–428 (2015).
Khaledi, M., Haghighatdoost, F., Feizi, A. & Aminorroaya, A. The prevalence of comorbid depression in patients with type 2 diabetes: an updated systematic review and meta-analysis on huge number of observational studies. Acta Diabetol. 56, 631–650 (2019).
Barnard, K. D., Skinner, T. C. & Peveler, R. The prevalence of co-morbid depression in adults with type 1 diabetes: systematic literature review. Diabet. Med. 23, 445–448 (2006).
Buchberger, B. et al. Symptoms of depression and anxiety in youth with type 1 diabetes: a systematic review and meta-analysis. Psychoneuroendocrinology 70, 70–84 (2016).
Cooney, L. G., Lee, I., Sammel, M. D. & Dokras, A. High prevalence of moderate and severe depressive and anxiety symptoms in polycystic ovary syndrome: a systematic review and meta-analysis. Hum. Reprod. 32, 1075–1091 (2017).
Mitchell, A. J. et al. Prevalence and predictors of post-stroke mood disorders: a meta-analysis and meta-regression of depression, anxiety and adjustment disorder. Gen. Hosp. Psychiatry 47, 48–60 (2017).
Ayerbe, L., Ayis, S., Wolfe, C. D. A. & Rudd, A. G. Natural history, predictors and outcomes of depression after stroke: systematic review and meta-analysis. Br. J. Psychiatry 202, 14–21 (2013).
Boeschoten, R. E. et al. Prevalence of depression and anxiety in multiple sclerosis: a systematic review and meta-analysis. J. Neurol. Sci. 372, 331–341 (2017).
Marrie, R. A. et al. Differences in the burden of psychiatric comorbidity in MS vs the general population. Neurology 85, 1972–1979 (2015).
McKay, K. A. et al. Psychiatric comorbidity is associated with disability progression in multiple sclerosis. Neurology 90, e1316–e1323 (2018).
Binzer, S., McKay, K. A., Brenner, P., Hillert, J. & Manouchehrinia, A. Disability worsening among persons with multiple sclerosis and depression: a Swedish cohort study. Neurology 93, e2216–e2223 (2019).
Kim, M., Kim, Y.-S., Kim, D.-H., Yang, T.-W. & Kwon, O.-Y. Major depressive disorder in epilepsy clinics: a meta-analysis. Epilepsy Behav. 84, 56–69 (2018).
Goodarzi, Z. et al. Detecting depression in Parkinson disease. Neurology 87, 426–437 (2016).
Chi, S. et al. The prevalence of depression in Alzheimer’s disease: a systematic review and meta-analysis. Curr. Alzheimer Res. 12, 189–198 (2015).
Zhang, L., Fu, T., Yin, R., Zhang, Q. & Shen, B. Prevalence of depression and anxiety in systemic lupus erythematosus: a systematic review and meta-analysis. BMC Psychiatry 17, 70 (2017).
Dowlatshahi, E. A., Wakkee, M., Arends, L. R. & Nijsten, T. The prevalence and odds of depressive symptoms and clinical depression in psoriasis patients: a systematic review and meta-analysis. J. Investig. Dermatol. 134, 1542–1551 (2014).
Matcham, F., Rayner, L., Steer, S. & Hotopf, M. The prevalence of depression in rheumatoid arthritis: a systematic review and meta-analysis. Rheumatology 52, 2136–2148 (2013).
Neuendorf, R., Harding, A., Stello, N., Hanes, D. & Wahbeh, H. Depression and anxiety in patients with inflammatory bowel disease: a systematic review. J. Psychosom. Res. 87, 70–80 (2016).
Mulugeta, A., Zhou, A., King, C. & Hyppönen, E. Association between major depressive disorder and multiple disease outcomes: a phenome-wide Mendelian randomisation study in the UK Biobank. Mol. Psychiatry 25, 1469–1476 (2019).
Tylee, D. S. et al. Genetic correlations among psychiatric and immune-related phenotypes based on genome-wide association data. Am. J. Med. Genet. B Neuropsychiatr. Genet. 177, 641–657 (2018).
Tyrrell, J. et al. Using genetics to understand the causal influence of higher BMI on depression. Int. J. Epidemiol. 48, 834–848 (2019).
Milaneschi, Y. et al. Genetic association of major depression with atypical features and obesity-related immunometabolic dysregulations. JAMA Psychiatry 74, 1214–1225 (2017).
Haljas, K. et al. Bivariate genome-wide association study of depressive symptoms with type 2 diabetes and quantitative glycemic traits. Psychosom. Med. 80, 242–251 (2018).
Samaan, Z. et al. Lack of association between type 2 diabetes and major depression: epidemiologic and genetic evidence in a multiethnic population. Transl Psychiatry 5, e618 (2015).
Clarke, T.-K. et al. Investigating shared aetiology between type 2 diabetes and major depressive disorder in a population based cohort. Am. J. Med. Genet. B Neuropsychiatr. Genet. 174, 227–234 (2016).
Khandaker, G. M. et al. Shared mechanisms between coronary heart disease and depression: findings from a large UK general population-based cohort. Mol. Psychiatry 25, 1477–1486 (2020).
Brainstorm Consortium. et al. Analysis of shared heritability in common disorders of the brain. Science 360, eaap8757 (2018).
Wang, J. S. et al. Examining the effect of 5-HTTLPR on depressive symptoms in postmenopausal women 1 year after initial breast cancer treatment. Support. Care Cancer 27, 513–519 (2019).
Ogrodnik, M. et al. Obesity-induced cellular senescence drives anxiety and impairs neurogenesis. Cell Metab. 29, 1061–1077 (2019).
Kennis, M. et al. Prospective biomarkers of major depressive disorder: a systematic review and meta-analysis. Mol. Psychiatry 25, 321–338 (2019).
Otte, C., Neylan, T. C., Pipkin, S. S., Browner, W. S. & Whooley, M. A. Depressive symptoms and 24-hour urinary norepinephrine excretion levels in patients with coronary disease: findings from the Heart and Soul study. Am. J. Psychiatry 162, 2139–2145 (2005).
Otte, C. et al. Depression and 24-hour urinary cortisol in medical outpatients with coronary heart disease: the Heart and Soul study. Biol. Psychiatry 56, 241–247 (2004).
Enache, D., Pariante, C. M. & Mondelli, V. Markers of central inflammation in major depressive disorder: a systematic review and meta-analysis of studies examining cerebrospinal fluid, positron emission tomography and post-mortem brain tissue. Brain Behav. Immun. 81, 24–40 (2019).
Köhler, C. A. et al. Peripheral cytokine and chemokine alterations in depression: a meta-analysis of 82 studies. Acta Psychiatr. Scand. 135, 373–387 (2017).
Osimo, E. F., Baxter, L. J., Lewis, G., Jones, P. B. & Khandaker, G. M. Prevalence of low-grade inflammation in depression: a systematic review and meta-analysis of CRP levels. Psychol. Med. 49, 1958–1970 (2019).
Orlovska-Waast, S. et al. Cerebrospinal fluid markers of inflammation and infections in schizophrenia and affective disorders: a systematic review and meta-analysis. Mol. Psychiatry 24, 869–887 (2018).
Hodes, G. E., Kana, V., Menard, C., Merad, M. & Russo, S. J. Neuroimmune mechanisms of depression. Nat. Neurosci. 18, 1386–1393 (2015).
Nerurkar, L., Siebert, S., McInnes, I. B. & Cavanagh, J. Rheumatoid arthritis and depression: an inflammatory perspective. Lancet Psychiatry 6, 164–173 (2019).
Kappelmann, N., Lewis, G., Dantzer, R., Jones, P. B. & Khandaker, G. M. Antidepressant activity of anti-cytokine treatment: a systematic review and meta-analysis of clinical trials of chronic inflammatory conditions. Mol. Psychiatry 23, 335–343 (2016).
Wittenberg, G. M. et al. Effects of immunomodulatory drugs on depressive symptoms: a mega-analysis of randomized, placebo-controlled clinical trials in inflammatory disorders. Mol. Psychiatry 25, 1275–1285 (2019).
Duivis, H. E. et al. Depressive symptoms, health behaviors, and subsequent inflammation in patients with coronary heart disease: prospective findings from the Heart and Soul study. Am. J. Psychiatry 168, 913–920 (2011).
Laake, J.-P. S. et al. The association between depressive symptoms and systemic inflammation in people with type 2 diabetes: findings from the South London Diabetes Study. Diabetes Care 37, 2186–2192 (2014).
Hayashino, Y., Mashitani, T., Tsujii, S. & Ishii, H. Elevated levels of hs-CRP are associated with high prevalence of depression in Japanese patients with type 2 diabetes: the Diabetes Distress and Care Registry at Tenri (DDCRT 6). Diabetes Care 37, 2459–2465 (2014).
Moulton, C. D., Pickup, J. C. & Ismail, K. The link between depression and diabetes: the search for shared mechanisms. Lancet Diabetes Endocrinol. 3, 461–471 (2015).
Carson, A. J. et al. Depression after stroke and lesion location: a systematic review. Lancet 356, 122–126 (2000).
Wei, N. et al. Post-stroke depression and lesion location: a systematic review. J. Neurol. 262, 81–90 (2014).
Padmanabhan, J. L. et al. A human depression circuit derived from focal brain lesions. Biol. Psychiatry 86, 749–758 (2019).
Allida, S. et al. Pharmacological, psychological, and non-invasive brain stimulation interventions for treating depression after stroke. Cochrane Database Syst. Rev. 1, CD0033437 (2020).
Gold, S. M. et al. Detection of altered hippocampal morphology in multiple sclerosis-associated depression using automated surface mesh modeling. Hum. Brain Mapp. 35, 30–37 (2012).
Rossi, S. et al. Neuroinflammation drives anxiety and depression in relapsing-remitting multiple sclerosis. Neurology 89, 1338–1347 (2017).
Corallo, F. et al. A complex relation between depression and multiple sclerosis: a descriptive review. Neurol. Sci. 40, 1551–1558 (2019).
Qato, D. M., Ozenberger, K. & Olfson, M. Prevalence of prescription medications with depression as a potential adverse effect among adults in the United States. JAMA 319, 2289–2298 (2018).
Verbeek, D. E. P., van Riezen, J., de Boer, R. A., van Melle, J. P. & de Jonge, P. A review on the putative association between beta-blockers and depression. Heart Fail. Clin. 7, 89–99 (2011).
Salagre, E., Fernandes, B. S., Dodd, S., Brownstein, D. J. & Berk, M. Statins for the treatment of depression: a meta-analysis of randomized, double-blind, placebo-controlled trials. J. Affect. Disord. 200, 235–242 (2016).
Kovacs, D., Kovacs, P., Eszlari, N., Gonda, X. & Juhasz, G. Psychological side effects of immune therapies: symptoms and pathomechanism. Curr. Opin. Pharmacol. 29, 97–103 (2016).
Udina, M. et al. Interferon-induced depression in chronic hepatitis C. J. Clin. Psychiatry 73, 1128–1138 (2012).
Schaefer, M. et al. Escitalopram for the prevention of peginterferon-α2a-associated depression in hepatitis C virus-infected patients without previous psychiatric disease: a randomized trial. Ann. Intern. Med. 157, 94–103 (2012).
Mann, T. K., Dail, R. B. & Bailey, D. E. Cognitive and affective symptoms experienced by cancer patients receiving high-dose intravenous interleukin 2 therapy: an integrative literature review. Cancer Nurs. 39, 349–357 (2016).
DellaGioia, N. & Hannestad, J. A critical review of human endotoxin administration as an experimental paradigm of depression. Neurosci. Biobehav. Rev. 34, 130–143 (2010).
Weinberger, A. H. et al. Depression and cigarette smoking behavior: a critical review of population-based studies. Am. J. Drug. Alcohol. Abuse 43, 416–431 (2016).
Forouzanfar, M. H. et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 388, 1659–1724 (2016).
Chauhan, G. et al. Genetic and lifestyle risk factors for MRI-defined brain infarcts in a population-based setting. Neurology 92, e486–e503 (2019).
Belbasis, L., Bellou, V., Evangelou, E., Ioannidis, J. P. A. & Tzoulaki, I. Environmental risk factors and multiple sclerosis: an umbrella review of systematic reviews and meta-analyses. Lancet Neurol. 14, 263–273 (2015).
Chaiton, M. O., Cohen, J. E., OtextquotesingleLoughlin, J. & Rehm, J. A systematic review of longitudinal studies on the association between depression and smoking in adolescents. BMC Public. Health 9, 356 (2009).
Ho, S. Y., Alnashri, N., Rohde, D., Murphy, P. & Doyle, F. Systematic review and meta-analysis of the impact of depression on subsequent smoking cessation in patients with chronic respiratory conditions. Gen. Hosp. Psychiatry 37, 399–407 (2015).
Patten, S. B., Williams, J. V. & Bulloch, A. G. Major depressive episodes and mortality in the Canadian household population. J. Affect. Disord. 242, 165–171 (2019).
Choi, K. W. et al. Assessment of bidirectional relationships between physical activity and depression among adults. JAMA Psychiatry 76, 399–408 (2019).
Whooley, M. A. et al. Depressive symptoms, health behaviors, and risk of cardiovascular events in patients with coronary heart disease. JAMA 300, 2379–2388 (2008).
Boden, J. M. & Fergusson, D. M. Alcohol and depression. Addiction 106, 906–914 (2011).
Lassale, C. et al. Healthy dietary indices and risk of depressive outcomes: a systematic review and meta-analysis of observational studies. Mol. Psychiatry 24, 965–986 (2018).
Molendijk, M., Molero, P., Ortuño Sánchez-Pedreño, F., Van der Does, W. & Angel Martínez-González, M. Diet quality and depression risk: a systematic review and dose-response meta-analysis of prospective studies. J. Affect. Disord. 226, 346–354 (2018).
Martínez-González, M. A., Gea, A. & Ruiz-Canela, M. The Mediterranean diet and cardiovascular health. Circulation Res. 124, 779–798 (2019).
Bot, M. et al. Effect of multinutrient supplementation and food-related behavioral activation therapy on prevention of major depressive disorder among overweight or obese adults with subsyndromal depressive symptoms. JAMA 321, 858–868 (2019).
Mausbach, B. T., Schwab, R. B. & Irwin, S. A. Depression as a predictor of adherence to adjuvant endocrine therapy (AET) in women with breast cancer: a systematic review and meta-analysis. Breast Cancer Res. Treat. 152, 239–246 (2015).
Kessing, D., Denollet, J., Widdershoven, J. & Kupper, N. Psychological determinants of heart failure self-care. Psychosom. Med. 78, 412–431 (2016).
Brown, S. A. et al. Biobehavioral determinants of glycemic control in type 2 diabetes: a systematic review and meta-analysis. Patient Educ. Couns. 99, 1558–1567 (2016).
Rieckmann, N. et al. Course of depressive symptoms and medication adherence after acute coronary syndromes. J. Am. Coll. Cardiol. 48, 2218–2222 (2006).
Folkman, S. in Encyclopedia of Behavioral Medicine (eds Gellman, M. D. & Turner, J. R.) 1913–1915 (Springer, 2013).
Heijmans, M. et al. The stress of being chronically ill: from disease-specific to task-specific aspects. J. Behav. Med. 27, 255–271 (2004).
Moss-Morris, R. Adjusting to chronic illness: time for a unified theory. Br. J. Health Psychol. 18, 681–686 (2013).
Clarke, D. M. & Currie, K. C. Depression, anxiety and their relationship with chronic diseases: a review of the epidemiology, risk and treatment evidence. Med. J. Aust. 190, S54–S60 (2009).
Detweiler-Bedell, J. B., Friedman, M. A., Leventhal, H., Miller, I. W. & Leventhal, E. A. Integrating co-morbid depression and chronic physical disease management: identifying and resolving failures in self-regulation. Clin. Psychol. Rev. 28, 1426–1446 (2008).
Sirois, F. M., Kitner, R. & Hirsch, J. K. Self-compassion, affect, and health-promoting behaviors. Health Psychol. 34, 661–669 (2015).
Schiavon, C. C., Marchetti, E., Gurgel, L. G., Busnello, F. M. & Reppold, C. T. Optimism and hope in chronic disease: a systematic review. Front. Psychol. 7, 2022 (2016).
Leventhal, H., Diefenbach, M. & Leventhal, E. A. Illness cognition: using common sense to understand treatment adherence and affect cognition interactions. Cognit. Ther. Res. 16, 143–163 (1992).
Trudel-Fitzgerald, C. et al. The relationship of perfectionism with psychological symptoms in cancer patients and the contributing role of hyperarousability and coping. Psychol. Health 32, 381–401 (2017).
Leventhal, H., Brissette, I. & Leventhal, E. A. in The Self-regulation of Health and Illness Behaviour (eds Cameron, L. D. & Leventhal, H.) 42–65 (Psychology Press, 2003).
Hagger, M. S., Koch, S., Chatzisarantis, N. L. D. & Orbell, S. The common sense model of self-regulation: meta-analysis and test of a process model. Psychol. Bull. 143, 1117–1154 (2017).
Uhlenbusch, N. et al. Depression and anxiety in patients with different rare chronic diseases: a cross-sectional study. PLoS ONE 14, e0211343 (2019).
Edwards, R. R., Cahalan, C., Mensing, G., Smith, M. & Haythornthwaite, J. A. Pain, catastrophizing, and depression in the rheumatic diseases. Nat. Rev. Rheumatol. 7, 216–224 (2011).
Edwards, R. R., Bingham, C. O., Bathon, J. & Haythornthwaite, J. A. Catastrophizing and pain in arthritis, fibromyalgia, and other rheumatic diseases. Arthritis Rheum. 55, 325–332 (2006).
Hudson, J. L. & Moss-Morris, R. Treating illness distress in chronic illness. Eur. Psychol. 24, 26–37 (2019).
Neff, K. Self-compassion: an alternative conceptualization of a healthy attitude toward oneself. Self Identity 2, 85–101 (2003).
Pinto-Gouveia, J., Duarte, C., Matos, M. & Fráguas, S. The protective role of self-compassion in relation to psychopathology symptoms and quality of life in chronic and in cancer patients. Clin. Psychol. Psychother. 21, 311–323 (2013).
Przezdziecki, A. et al. My changed body: breast cancer, body image, distress and self-compassion. Psychooncology 22, 1872–1879 (2012).
Sirois, F. M. & Rowse, G. The role of self-compassion in chronic illness care. J. Clin. Outcome Manag. 23, 521–527 (2016).
Stange, J. P., Alloy, L. B. & Fresco, D. M. Inflexibility as a vulnerability to depression: a systematic qualitative review. Clin. Psychol. Sci. Pract. 24, 245–276 (2017).
Gentili, C. et al. Psychological flexibility as a resilience factor in individuals with chronic pain. Front. Psychol. 10, 2016 (2019).
Dimidjian, S., Barrera, M., Martell, C., Muñoz, R. F. & Lewinsohn, P. M. The origins and current status of behavioral activation treatments for depression. Annu. Rev. Clin. Psychol. 7, 1–38 (2011).
Shear, M. K. et al. Optimizing treatment of complicated grief: a randomized clinical trial. JAMA Psychiatry 73, 685–694 (2016).
Whooley, M. A., Avins, A. L., Miranda, J. & Browner, W. S. Case-finding instruments for depression. J. Gen. Intern. Med. 12, 439–445 (1997).
Bosanquet, K. et al. Diagnostic accuracy of the Whooley questions for the identification of depression: a diagnostic meta-analysis. BMJ Open 5, e008913 (2015).
Colquhoun, D. M. et al. Screening, referral and treatment for depression in patients with coronary heart disease. Med. J. Aust. 198, 483–484 (2013).
World Health Organization. mhGAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings – version 2 (WHO, 2016).
Shepard, N. & Parker, C. Depression in adults: recognition and management. Clin. Pharm. https://doi.org/10.1211/cp.2017.20202439 (2017).
Kroenke, K., Spitzer, R. L. & Williams, J. B. W. The patient health questionnaire-2. Med. Care 41, 1284–1292 (2003).
Manea, L. et al. Identifying depression with the PHQ-2: a diagnostic meta-analysis. J. Affect. Disord. 203, 382–395 (2016).
Whooley, M. A. Screening for depression — a tale of two questions. JAMA Intern. Med. 176, 436–438 (2016).
Levis, B. et al. Accuracy of the PHQ-2 alone and in combination with the PHQ-9 for screening to detect major depression: systematic review and meta-analysis. JAMA 323, 2290–2300 (2020).
Kroenke, K., Spitzer, R. L. & Williams, J. B. W. The PHQ-9. J. Gen. Intern. Med. 16, 606–613 (2001).
Gilbody, S., Richards, D., Brealey, S. & Hewitt, C. Screening for depression in medical settings with the patient health questionnaire (PHQ): a diagnostic meta-analysis. J. Gen. Intern. Med. 22, 1596–1602 (2007).
Mitchell, A. J., Yadegarfar, M., Gill, J. & Stubbs, B. Case finding and screening clinical utility of the patient health questionnaire (PHQ-9 and PHQ-2) for depression in primary care: a diagnostic meta-analysis of 40 studies. BJPsych Open 2, 127–138 (2016).
Archer, J. et al. Collaborative care for depression and anxiety problems. Cochrane Database Syst. Rev. 10, CD006525 (2012).
Panagioti, M. et al. Association between chronic physical conditions and the effectiveness of collaborative care for depression: an individual participant data meta-analysis. JAMA Psychiatry 73, 978–989 (2016).
Cipriani, A. et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Lancet 391, 1357–1366 (2018).
Rayner, L. et al. Antidepressants for depression in physically ill people. Cochrane Database Syst. Rev. 391, CD007503 (2010).
Ostuzzi, G. et al. Efficacy and acceptability of antidepressants in patients with ischemic heart disease. Int. Clin. Psychopharmacol. 34, 65–75 (2019).
Ostuzzi, G., Benda, L., Costa, E. & Barbui, C. Efficacy and acceptability of antidepressants on the continuum of depressive experiences in patients with cancer: systematic review and meta-analysis. Cancer Treat. Rev. 41, 714–724 (2015).
Baumeister, H., Hutter, N. & Bengel, J. Psychological and pharmacological interventions for depression in patients with diabetes mellitus: an abridged Cochrane review. Diabet. Med. 31, 773–786 (2014).
Price, A. et al. Antidepressants for the treatment of depression in neurological disorders: a systematic review and meta-analysis of randomised controlled trials. J. Neurol. Neurosurg. Psychiatry 82, 914–923 (2011).
Xu, X. et al. Efficacy and feasibility of antidepressant treatment in patients with post-stroke depression. Medicine 95, e5349 (2016).
Bomasang-Layno, E., Fadlon, I., Murray, A. N. & Himelhoch, S. Antidepressive treatments for Parkinson’s disease: a systematic review and meta-
Fiest, K. M. et al. Systematic review and meta-analysis of interventions for depression and anxiety in persons with multiple sclerosis. Mult. Scler. Relat. Disord. 5, 12–26 (2016).
Ostuzzi, G., Matcham, F., Dauchy, S., Barbui, C. & Hotopf, M. Antidepressants for the treatment of depression in people with cancer. Cochrane Database Syst. Rev. https://doi.org/10.1002/14651858.cd011006.pub3 (2018).
Fiest, K. M. et al. Systematic review and meta-analysis of interventions for depression and anxiety in persons with rheumatoid Arthritis. J. Clin. Rheumatol. 23, 425–434 (2017).
Fiest, K. M. et al. Systematic review of interventions for depression and anxiety in persons with inflammatory bowel disease. BMC Res. Notes 9, 404 (2016).
Madhusoodanan, S., Velama, U., Parmar, J., Goia, D. & Brenner, R. A current review of cytochrome P450 interactions of psychotropic drugs. Ann. Clin. Psychiatry 26, 120–138 (2014).
Rosenblat, J. D., Lee, Y. & McIntyre, R. S. The effect of pharmacogenomic testing on response and remission rates in the acute treatment of major depressive disorder: a meta-analysis. J. Affect. Disord. 241, 484–491 (2018).
Kim, B. Y., Sharafoddini, A., Tran, N., Wen, E. Y. & Lee, J. Consumer mobile apps for potential drug-drug interaction check: systematic review and content analysis using the mobile app rating scale (MARS). JMIR Mhealth Uhealth 6, e74 (2018).
Apidi, N. A. et al. Mobile medical applications for dosage recommendation, drug adverse reaction, and drug interaction. Ther. Innov. Regul. Sci. 51, 480–485 (2017).
Eshun-Wilson, I. et al. Antidepressants for depression in adults with HIV infection. Cochrane Database Syst. Rev. https://doi.org/10.1002/14651858.cd008525.pub3 (2018).
Zimmermann-Viehoff, F., Kuehl, L. K., Danker-Hopfe, H., Whooley, M. A. & Otte, C. Antidepressants, autonomic function and mortality in patients with coronary heart disease: data from the heart and soul study. Psychol. Med. 44, 2975–2984 (2014).
Taylor, D. Antidepressant drugs and cardiovascular pathology: a clinical overview of effectiveness and safety. Acta Psychiatr. Scand. 118, 434–442 (2008).
Pizzi, C. et al. Meta-analysis of selective serotonin reuptake inhibitors in patients with depression and coronary heart disease. Am. J. Cardiol. 107, 972–979 (2011).
Beach, S. R. et al. Meta-analysis of selective serotonin reuptake inhibitor–associated QTc prolongation. J. Clin. Psychiatry 75, e441–e449 (2014).
Assimon, M. M., Brookhart, M. A. & Flythe, J. E. Comparative cardiac safety of selective serotonin reuptake inhibitors among individuals receiving maintenance hemodialysis. J. Am. Soc. Nephrol. 30, 611–623 (2019).
Bahar, M. A., Kamp, J., Borgsteede, S. D., Hak, E. & Wilffert, B. The impact of CYP2D6 mediated drug-drug interaction: a systematic review on a combination of metoprolol and paroxetine/fluoxetine. Br. J. Clin. Pharmacol. 84, 2704–2715 (2018).
Köhler-Forsberg, O. et al. Efficacy of anti-inflammatory treatment on major depressive disorder or depressive symptoms: meta-analysis of clinical trials. Acta Psychiatri. Scand. 139, 404–419 (2019).
Bu, D., Griffin, G. & Lichtman, A. H. Mechanisms for the anti-inflammatory effects of statins. Curr. Opin. Lipidol. 22, 165–170 (2011).
Abajo, F. J. de & García-Rodríguez, L. A. Risk of upper gastrointestinal tract bleeding associated with selective serotonin reuptake inhibitors and venlafaxine therapy. Arch. Gen. Psychiatry 65, 795–803 (2008).
Spina, E., Barbieri, M. A., Cicala, G., Bruno, A. & de Leon, J. Clinically relevant drug interactions between newer antidepressants and oral anticoagulants. Expert. Opin. Drug. Metab. Toxicol. 16, 31–44 (2020).
Yoon, J. M., Cho, E.-G., Lee, H.-K. & Park, S. M. Antidepressant use and diabetes mellitus risk: a meta-analysis. Korean J. Fam. Med. 34, 228–240 (2013).
Domecq, J. P. et al. Drugs commonly associated with weight change: a systematic review and meta-analysis. J. Clin. Endocrinol. Metab. 100, 363–370 (2015).
Roopan, S. & Larsen, E. R. Use of antidepressants in patients with depression and comorbid diabetes mellitus: a systematic review. Acta Neuropsychiatr. 29, 127–139 (2016).
Williams, L. J. et al. Selective serotonin reuptake inhibitors (SSRIs) and markers of bone turnover in men. Calcif. Tissue Int. 103, 125–130 (2018).
Brännström, J., Lövheim, H., Gustafson, Y. & Nordström, P. Association between antidepressant drug use and hip fracture in older people before and after treatment initiation. JAMA Psychiatry 76, 172–179 (2019).
Maguire, M. J., Weston, J., Singh, J. & Marson, A. G. Antidepressants for people with epilepsy and depression. Cochrane Database Syst. Rev. https://doi.org/10.1002/14651858.CD010682.pub2 (2014).
Monaco, F. & Cicolin, A. Interactions between anticonvulsant and psychoactive drugs. Epilepsia 40, s71–s76 (1999).
Ogawa, Y. et al. Antidepressants plus benzodiazepines for adults with major depression. Cochrane Database Syst. Rev. 6, CD001026 (2019).
Gasim, M. et al. Adverse psychiatric effects of disease-modifying therapies in multiple sclerosis: a systematic review. Mult. Scler. Relat. Disord. 26, 124–156 (2018).
Deutsche Gesellschaft für Neurologie. Idiopathisches Parkinson-Syndrom in Leitlinien für Diagnostik und Therapie in der Neurologie (DGN, 2016).
Lederberg, M. S. & Holland, J. C. in Handbook of Psychotherapy in Cancer Care Ch. 1 (Watson, M. & Kissane, D. W.) 1–14 (John Wiley & Sons, Ltd, 2011).
Faller, H. et al. Effects of psycho-oncologic interventions on emotional distress and quality of life in adult patients with cancer: systematic review and meta-analysis. J. Clin. Oncol. 31, 782–793 (2013).
Okuyama, T., Akechi, T., Mackenzie, L. & Furukawa, T. A. Psychotherapy for depression among advanced, incurable cancer patients: a systematic review and meta-analysis. Cancer Treat. Rev. 56, 16–27 (2017).
Bortolato, B. et al. Depression in cancer: The many biobehavioral pathways driving tumor progression. Cancer Treat. Rev. 52, 58–70 (2017).
Lutgendorf, S. K. & Andersen, B. L. Biobehavioral approaches to cancer progression and survival: mechanisms and interventions. Am. Psychologist 70, 186–197 (2015).
Hartung, T. J. et al. The hospital anxiety and depression scale (HADS) and the 9-item patient health questionnaire (PHQ-9) as screening instruments for depression in patients with cancer: depression screening in oncology. Cancer 123, 4236–4243 (2017).
Wang, S.-B. et al. Cognitive behavioral therapy for post-stroke depression: a meta-analysis. J. Affect. Disord. 235, 589–596 (2018).
Hackett, M. L., Anderson, C. S., House, A. & Xia, J. Interventions for treating depression after stroke. Cochrane Database Syst. Rev. https://doi.org/10.1002/14651858.cd003437.pub3 (2008).
Ghielen, I. et al. The effects of cognitive behavioral and mindfulness-based therapies on psychological distress in patients with multiple sclerosis, Parkinson’s disease and Huntington’s disease: two meta-analyses. J. Psychosom. Res. 122, 43–51 (2019).
Hind, D. et al. Cognitive behavioural therapy for the treatment of depression in people with multiple sclerosis: a systematic review and meta-analysis. BMC Psychiatry 14, 5 (2014).
Reavell, J., Hopkinson, M., Clarkesmith, D. & Lane, D. A. Effectiveness of cognitive behavioral therapy for depression and anxiety in patients with cardiovascular disease. Psychosom. Med. 80, 742–753 (2018).
Li, C. et al. A systematic review and meta-analysis of randomized controlled trials of cognitive behavior therapy for patients with diabetes and depression. J. Psychosom. Res. 95, 44–54 (2017).
Chew, B. H., Vos, R. C., Metzendorf, M.-I., Scholten, R. J. & Rutten, G. E. Psychological interventions for diabetes-related distress in adults with type 2 diabetes mellitus. Cochrane Database Syst. Rev. 9, CD011469 (2017).
Graham, C. D., Gouick, J., Krahé, C. & Gillanders, D. A systematic review of the use of acceptance and commitment therapy (ACT) in chronic disease and long-term conditions. Clin. Psychol. Rev. 46, 46–58 (2016).
Gold, S. M. et al. Control conditions for randomised trials of behavioural interventions in psychiatry: a decision framework. Lancet Psychiatry 4, 725–732 (2017).
UK ECT Review Group. Efficacy and safety of electroconvulsive therapy in depressive disorders: a systematic review and meta-analysis. Lancet 361, 799–808 (2003).
Meyer, J. P., Swetter, S. K. & Kellner, C. H. Electroconvulsive therapy in geriatric psychiatry: a selective review. Psychiatr. Clin. North. Am. 41, 79–93 (2018).
van Diermen, L. et al. Prediction of electroconvulsive therapy response and remission in major depression: meta-analysis. Br. J. Psychiatry 212, 71–80 (2018).
Semkovska, M. & McLoughlin, D. M. Objective cognitive performance associated with electroconvulsive therapy for depression: a systematic review and meta-analysis. Biol. Psychiatry 68, 568–577 (2010).
Mutz, J. et al. Comparative efficacy and acceptability of non-surgical brain stimulation for the acute treatment of major depressive episodes in adults: systematic review and network meta-analysis. BMJ 364, l1079 (2019).
Authors
Copyright (c) 2025 Aiman Ali Ebrahem Shehab, Abdulrahman Ahmed Mohammed Moafa, Mohammed Othman Ibrahim Kamili, Alaaldeen Ahmed Ibrahim Shehab, Mohammed Ahmed M Moafa, Ibrahim Mohammed Ali Muallim, Khalid Mohammed Ali Sahli, Nasser Mohsen Nasser Aljafery, Anwar Ali Hakami, Akram Abdulkarim Al-Juhani, Fahad Ali Mohammad Sweidi, Adel Mohammed Mousa Hamzi
This work is licensed under a Creative Commons Attribution 4.0 International License.