The Psychiatric–Medical Comorbidity section will focus on the prevalence and impact of psychiatric disorders in patients with chronic medical illness as well as the prevalence and impact of medical disorders in patients with chronic psychiatric illness. Psychiatric–Medical Comorbidity Major depression after breast cancer: a review of epidemiology and treatment Jesse R. Fann, M.D., M.P.H. a,b,d,e, ⁎ , Anne M. Thomas-Rich, M.D. a , Wayne J. Katon, M.D. a , Deborah Cowley, M.D. a , Mary Pepping, Ph.D. b , Bonnie A. McGregor, Ph.D. f , Julie Gralow, M.D. c a Department of Psychiatry and Behavioral Sciences, University of Washington, P.O. Box 356560, Seattle, WA 98195, USA b Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195, USA c Department of Medicine, University of Washington, Seattle, WA 98195, USA d Department of Epidemiology, University of Washington, Seattle, WA 98195, USA e Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA f Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA Received 26 June 2007; accepted 25 October 2007 Abstract Objective: While many breast cancer patients experience “normal” distress, there is a subset who experience clinically significant depression. We examined the current knowledge about the prevalence, impact and treatment of major depression in women with breast cancer. Method: We reviewed the evidence for the prevalence of depression in women with breast cancer from the last 20 years and summarized the medical literature on the pharmacology and psychotherapy of depression in this population. Results: Despite evidence that depression significantly impacts quality of life in breast cancer patients, few studies focus on the epidemiology and treatment of major depression. Treatment studies have focused on distress and mixed depressive states, with resulting lack of replicable studies showing treatment efficacy. Potential biological and psychosocial determinants of major depression following breast cancer are discussed in a proposed model. The need for further research on the epidemiology and treatment of major depression in this population is proposed. Conclusion: Major depression is a frequent but underrecognized and undertreated condition among breast cancer patients, which causes amplification of physical symptoms, increased functional impairment and poor treatment adherence. More research on the epidemiology and treatment of major depression in this population is needed. © 2008 Elsevier Inc. All rights reserved. Keywords: Depression; Distress; Breast cancer; Epidemiology; Treatment 1. Introduction Breast cancer is the most common malignancy among women worldwide, with 178 480 new cases in the United States each year [1]. As early detection and treatment have improved, survival rates have increased to the extent that 89% now survive 5 years beyond diagnosis [1]. Thus, focus has turned toward maximizing quality of life (QOL) among survivors who often experience persisting aversive symp- toms such as fatigue, cognitive problems and menopausal symptoms [2,3]. Breast cancer diagnosis and treatment, and the months following primary therapy, are stressful times for most women. While many experience “normal” distress, there is a subset that experience clinically significant depression that may benefit from specialized psychiatric intervention. Available online at www.sciencedirect.com General Hospital Psychiatry 30 (2008) 112 – 126 ⁎ Corresponding author. Department of Psychiatry and Behavioral Sciences, University of Washington, P.O. Box 356560, Seattle, WA 98195, USA. Tel.: +1 206 685 4280. E-mail address: fann@u.washington.edu (J.R. Fann). 0163-8343/$ – see front matter © 2008 Elsevier Inc. All rights reserved. doi:10.1016/j.genhosppsych.2007.10.008