Fatigue, insomnia, anorexia weight loss may appear due to the medical illness rather than depression. Nevertheless, randomized control trials have shown antidepressants to be effective in patients who had depression in addition to having diabetes, or AIDS, coronary artery disease, cancer, or chronic obstructive pulmonary disease. Given one of these diseases or another chronic medical illness, which antidepressant should one choose. The choice depends on the particular medical disease, the side effects of the antidepressant, and other symptoms the patient may have. For example, for a terminally ill patient usually our first choice would be a stimulant because the onset of action is so much faster than an antidepressant.
Time is of the essence.
In a patient who had a myocardial infarction, we would generally avoid tricyclic antidepressants because they of their antiarrhythmic activity may increase mortality risks after myocardial infarction. Our next question. First answer is with humility. It is often not easy and these next couple of slides will illustrate some of the difficulties. Depression of course is characterized by mood disturbance.