Mood disorders in the general hospital setting

Mood disorders are more common in the general hospital setting than in the population as a whole, affecting 20% or more of those diagnosed with a serious physical illness. Special attention needs to be paid to possible organic causes of depressive symptoms and to effects of drugs. A further common presentation of mood disorders in this setting is via somatic symptoms such as pain and fatigue. It should not be assumed that depression is a normal response to illness. Furthermore, depression can adversely affect the prognosis for many disorders such as ischaemic heart disease, diabetes and stroke. Evidence now indicates that treating depression can improve the prognosis for these conditions. Thus, it is important that steps are taken not to miss depression when it is present. Treatment should include the standard evidence based pharmacological and psychological therapies, carefully chosen to be compatible with the effects of any organic illness present and with other prescribed medication. Special attention needs to be given to the risk of suicide which is elevated when depression and physical illness co-exist.