General Medical Conditions Cooccurring with Major
Ongoing attention to pharmacotherapy of individuals with asthma relates
to the use of bronchodilators and steroid inhal-ers for asthma. These may
complicate associated anxiety and depression and must be addressed carefully in
consideration of appropriate antidepressant therapy. Generally, SSRIs and newer
antidepressants appear to be well tolerated with typical asthma treatments.
SSRIs, newer mixed noradrenergic and serotonergic reuptake in-hibitors,
bupropion and ECT are likely to be safe treatments for patients with cardiac
disease (Glassman et al., 2002).
In individuals with epilepsy and MDD, adjunctive antidepressant
medications, particularly SSRIs and bupropion are well tolerated in combination
with most anticonvulsant treatments.
Previously, tricyclic antidepressants with anticholinergic proper-ties
were known to precipitate acute angle closure glaucoma in vulnerable patients.
The effect on intraocular pressure is benign with newer antidepressant
Many older antihypertensive treatments including reserpine and alpha
methyldopa were reported to precipitate depres-sion. Fatigue, lethargy and
possible depression were associated with beta-adrenergic blockers. Newer
antihypertensive drugs including angiotensin converting enzyme inhibitors
(ACEI) and calcium channel blockers have fewer side effects and are tolerated
well in combination with standard antidepressant treatments.
There is prominent cooccurrence of MDD with Parkinson’s dis-ease. The
prescription of low dose SSRIs, bupropion and mixed noradrenergic serotonergic
reuptake inhibitors may be helpful in the management of comorbid MDD and
Parkinson’s disease without risk of worsening the underlying movement disorder
or promoting psychosis.