Major depressive disorder (MDD), or depression, is a feeling of sadness that interferes with your daily activities and ability to do the things you enjoy. Individuals with depression may also have comorbid mental disorders that can make it even more difficult to get through the day.
Comorbidity refers to two or more illnesses occurring at the same time in the same individual. Comorbid conditions are associated with distinct challenges and consequences. For example, if symptoms go unresolved, individuals may see a loss of productivity through multiple days off work. More gravely, the diagnosis of depression and a comorbid mental health condition has been associated with an increased risk of suicide. With understanding of these comorbidities, there is hope to address issues and avoid negative outcomes.
Conditions That Coexist With Depression
Major depressive disorder, often characterized by feeling overwhelmingly sad, can coexist with other mental illnesses. MDD may be due, in part, to a decrease in serotonin, norepinephrine, and/or dopamine. A shift in these neurotransmitters can also contribute to an anxiety disorder, panic disorder, or another mental health concern.
Dr. Ashley C. Keays, DO, MPH, FAAFP, physician, and owner of Keays Medical Group, explains that many patients have comorbid psychiatric disorders, and healthcare providers should be mindful of this when diagnosing and treating patients.
Comorbidity #1: Depression and Anxiety
Anxiety is characterized by a feeling of worry or fear. When this feeling doesn't go away and it interferes with your daily activities, you may have an anxiety disorder.
Nearly one-half of individuals with depression also have an anxiety disorder. Dealing with depression on its own can be difficult, but managing both conditions can be particularly challenging.
"Fortunately, a lot of medications that treat depression can also be used for anxiety," says Dr. Keays. For those with co-occurring depression and anxiety, one medication may manage symptoms from both illnesses. Your healthcare provider may consider one or more of these medications when discussing treatment options.
It is not clear why comorbid depression and anxiety is so frequent. One explanation is that they share many symptoms, increasing the chances of meeting the criteria for both. This comorbidity may also be explained by shared genetic traits and physiological mechanisms between anxiety and depression.
Comorbidity #2: Depression and Panic Disorder
Panic disorder is characterized by episodes of intense fear (panic), as well as physical symptoms like a racing heart, sweating, shortness of breath, and dizziness or nausea. About 50% of people with panic disorder have at least one episode of major depression. Major stress, a family history of panic disorder, a traumatic event, or another mental health condition such as a social phobia or obsessive-compulsive disorder can also increase the risk of a panic disorder. Alterations in serotonin signaling may represent a shared root between these two conditions.
This double diagnosis can make an individual's journey more challenging, as symptoms may be more severe and cause increased impairments.
Comorbidity #3: Depression and PTSD
Post-traumatic stress disorder (PTSD) is a mental health condition often triggered by a traumatic event. Symptoms may include nightmares, excessive worry, and flashbacks.
Co-occurring depression and PTSD is also common. Nearly half of those diagnosed with PTSD have comorbid depression. Although this co-existing condition may diminish quality of life, most of the pharmacologic treatment options for PTSD are also antidepressants commonly used in depression management .
The reasons why the two conditions occur together are not completely understood. It may be due to overlapping symptoms, or other risk factors such as childhood trauma or having the personality trait of neuroticism.
Comorbidity #4: Physical Conditions That Co-Occur With Depression
About 50% of patients with depression have a physical comorbidity.
Other health conditions that may co-occur with depression include:
- Hypertension – individuals with MDD may have a higher prevalence of high blood pressure when compared to the average population.
- Diabetes – individuals with depression have a 41% increased risk for developing all types of diabetes and specifically, a 32% increased risk for developing type 2 diabetes.
- Heart diseases – previous data has highlighted that individuals with major depression more commonly report cardiovascular disease than non-depressed peers.
- Cancer – a diagnosis of depression and increased depressive symptom severity have been associated with an increased risk of mortality in cancer patients.
Treating Multiple Conditions
Patients with co-occurring mental health disorders may be more likely to take several medications to relieve their physical and mental symptoms. While it can be necessary, polypharmacy, or taking multiple medications, can increase the risk of medication side effects and drug interactions, while also having the potential to significantly increase healthcare costs.
Furthermore, having multiple conditions may affect how you respond to treatment and many patients may experience medication trial and error. "Most patients that come to me have already failed multiple medications," says Dr. Keays.
Genetic Testing for Treatment of Mental Health Conditions
Not all medications work the same for everyone. For example, you may have gene variants that can contribute to how effective certain medications may be in alleviating your symptoms.
According to Dr. Keays, anyone with multiple medication failures, or a complex mental health history, may be an excellent candidate for genetic testing.
"These individuals may need a different medication or need more than one medication, and it’s really helpful to have a guide to make sure I’m not prescribing things that will counteract each other. So, to have a tool like Genomind’s GenMed✔ Pro™ is an excellent way to check if they are ok together", says Dr. Keays. She often discusses genetic testing with patients during their first appointment.
Dr. Keays chooses to use Genomind's pharmacogenetic testing and services. Genomind® Professional PGx Express™ looks at 24 genes related to mental health treatment for depression and comorbid conditions. It provides guidance across 10+ mental health conditions and 130+ medications to help clinicians determine:
- Which medications may be more or less likely to be effective
- Which medications may be less likely to have side effects
- How you metabolize medications for personalized dosing guidance
The Genomind® PGx test can be done at a clinician’s office—or from the comfort of your home. It requires a prescription, and Genomind can help connect you with a verified Genomind® provider near you. Get started by filling out this form.
Analyzing Gene-Drug & Drug-Drug Interactions
Once you have taken the test, your clinician can use Genomind's patent-pending medication management software GenMed✔ Pro™. This is specifically designed to support the care of individuals taking several medications. The software utilizes Genomind PGx results to identify possible drug-drug or drug-gene interactions, in relation to the individual patient’s genetic profile. This tool provides personalized guidance on the most common medications used to treat depression and other comorbid conditions.
Appropriate Treatment Options
Appropriate medication(s) and dosage can make all the difference in treating comorbid mental health conditions. If you have mental health concerns and your current treatment is not effective in reducing your symptoms, discuss genetic testing with your healthcare provider. Genetic testing is designed to minimize trial and error in an effort to reduce symptoms without causing side effects.
"Just looking at the correct medication makes a huge difference. It gives patients the confidence to know that we’re going to try a drug that may work and be tolerated the first time. It has changed the way we practice medicine", says Dr. Keays.
About the Contributor
Dr. Ashley Keays, D.O., MPH, FAAFP
Dr. Ashley Keays is a patient focused physician that understands how vital the physician – patient relationship is to an individual’s care. She is a board certified family practice physician and a Fellow of the American Academy of Family Physicians.
Dr. Keays graduated from Nova Southeastern University in 2004 with dual degrees as a Doctor of Osteopathic Medicine and a Masters in Public Health. Through her years in family medicine, she found a passion for treating patients with fibromyalgia and chose to dedicate her practice to providing multidisciplinary, comprehensive fibromyalgia care.