ORIGINAL ARTICLES SOMATIC COMORBIDITIES IN UNIPOLAR DEPRESSION Daniela G. Glavan 1,2 , Ion Udristoiu 1,2 , Cerasela Sarbu 2,3 , Anca L. Chirita 2 , Traian Purnichi 3 , Mihail C. Pirlog 4 Introduction Epidemiological research has emphasized the fact that, in the case of unipolar depression, there is a high rate of comorbid associations with various medical conditions, which may significantly complicate both the disease prognosis and the psychopharmacological treatment, as well as the quality of the therapeutic response. The presence of somatic comorbidities is a major risk factor for the outcome of psychiatric disorders, with a 1.6-3 times higher mortality rate in this category of patients (1) that require a specific approach regarding the primary care, specialized care and treatment priorities. The depressive disorder is an important part of the cardiovascular pathology, given the fact that it constitutes a risk factor in the initial stages of the disorder, and it can also lead to an unfavorable prognosis (2). The epidemiological data show a nearly 20% prevalence of depressive disorders in patients also suffering from cardiovascular diseases, with three times more frequent instances of psychiatric disorders in these patients than in general population (3). Depression can be generated by the side effects of cardiology medication (beta-blockers, thiazide diuretics, angiotensin-converting-enzyme inhibitors, antiadrenergic agents, some antiarrhythmic medicines, digital drugs) (4, 5). Another frequent comorbidity in depression is hyperglycemia, people suffering from diabetes having a three times higher risk of developing depressive disorders, compared to the general population. Almost 20% of the diabetic patients (6), and particularly those with Type 2 diabetes, have severe depressive symptoms (7) that increase with 86% the costs of care in these patients compared to the care of the patients with diabetes only (8). The comorbidity of these two medical conditions may also appear as a side effect of the antidepressant or antipsychotic medication used to treat depression (9). Depressive disorders occur in 10-27% of the people having survived a cerebrovascular accident, with symptoms occurring for approximately one year. Another 15-40% of the patients show signs of depression during the first two months after the stroke (10). The stroke mortality rate was also 50% higher in the case of depressive patients (11). Depression also occurs in over 25% of the patients having been diagnosed with cancer. However, the depressive symptomatology is often mistaken for the side effects of the corticosteroid treatment or chemotherapy, or for the cancer symptoms which cause a loss of appetite and weight, insomnia and fatigue (12). This leads to a high rate of underdiagnoses in 40-90% of the patients (13). Depression is also associated with hepatitis C. This association is a significant factor for the negative outcome of both conditions, when the effects of the immunosuppressant or antidepressant drugs play an important part in the entire process (14). Also, associated with depressive disorders, obesity is related to the hyperactivity of the hypothalamic–pituitary–adrenal axis, to high cortisol levels and to the side effects of some psychotropic substances (antidepressants, antipsychotics, mood stabilizers). Also, the overweight depressive patients have cognitive dysfunction that is correlated with structural abnormalities of the brain at the level of the white matter, hypothalamus, hippocampus, cingulate gyrus and basal ganglia (15). The depressive disorder is merely one of the manifestations of the neurodegenerative diseases prodromal and it is also a risk factor for the increase of dysfunctionalities generated by this type of disorders. In Alzheimer's disease, depression occurs along with the Mild Cognitive Impairment (MCI) syndrome, and it has a 1. MD, PhD University of Medicine and Pharmacy of Craiova; Corresponding address: Clinical Hospital of Neuropsychiatry Craiova, 2nd Clinic, Calea Bucuresti 199, 0040723615638, danaglavan@gmail.com. 2. MD, PhD Clinical Hospital of Neuropsychiatry Craiova. 3. PhD student, University of Medicine and Pharmacy of Craiova – Doctoral School; 4. PhD, University of Medicine and Pharmacy of Craiova Received February 25, 2017, Revised March 26, 2017, Accepted April 17, 2017 Abstract The somatic comorbidities in unipolar depression are a potential risk not only for the unfavorable course, but also increase the social and economic burden of this disorder A study conducted on a group of 5054 patients with depressive disorders that were hospitalized in the Neuropsychiatric Hospital of Craiova over a period of 5 years has shown a relatively high frequency of cardiovascular diseases and hyperglycemia, especially in women. The unfavorable course of the mental disorder was significantly associated with a higher frequency of somatic comorbidities, more hospitalizations and a longer duration of hospitalization. These results demonstrate the importance of the multidisciplinary approach for any comorbid association between mental and somatic disorders to improve the outcome of the medical treatment and to ensure a good recovery of the depressive episode. Keywords: depressive disorder, cardiovascular disease, diabetes, burden of disease, hospitalization. 97 Ref: Ro J Psychiatry Psychother.2017;19(3) DOI: 10.37897/RJPP.2017.3.4 Article History: Received: 25 February 2017 Accepted: 17 April 2017 Corresponding author: Daniela G. Glavan E-mail: danaglavan@gmail.com