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General Medical Conditions Cooccurring with Major Depressive Disorder
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 treatments.
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.
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