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Adapting Depression Treatment in Patients With Comorbid Medical Conditions

April 13, 2021

(Part 3 of a 4-part series)

In this video, Jonathan E. Alpert, MD, PhD, of Albert Einstein College of Medicine and Montefiore Medical Center, New York City, New York, discusses strategies for adapting depression treatment in patients who also have medical comorbidities. Dr. Alpert recently presented "Treating Depression with Other Medical Comorbidity" at the Nevada Psychiatric Association's 26th National Psychopharmacology Update.

In the next installment of this video series, Dr. Alpert will discuss special considerations for patients with both depression and COVID‑19.

Part 1: Dr. Jonathan Alpert on Medical Comorbidities in Patients With Depression

Part 2: Medical Conditions With High Rates of Co-Occurring Depression and Related Research Gaps


Read the transcript:

When clinicians are adapting treatment of depression for people with comorbid conditions, there are a number of important considerations. There's been a longstanding precept to start low and go slow, particularly when it comes to medication treatment.

Understanding that people with medical comorbidities are likely to be on a range of other medications, there may be drug‑drug interactions and other factors. Also, the way they metabolize and handle medications may be different.

However, that precept can be taken too far. That although we might start low and go slow, we also understand that depression in the setting of medical conditions often proves to be more stubborn to treat. So we might start low and go slow, but we need to persevere and be quite assertive in terms of treatment.

That includes both medication treatments but also drawing upon all modalities of treatment, including specific forms of psychotherapy, and also thinking about neuromodulation, including electroconvulsive therapy, which has very few medical contraindications associated with it and is particularly important to think about in people with severe depression compromised by medical comorbidity.


Jonathan E. Alpert, MD, PhD, is the Dorothy and Marty Silverman University Chair of the Department of Psychiatry and Behavioral Sciences and Professor of Psychiatry, Neuroscience and Pediatrics at the Albert Einstein College of Medicine and Montefiore Medical Center, New York City, New York. He is also Chair of the American Psychiatric Association Council on Research. Before joining Montefiore Einstein in 2017, Dr. Alpert worked at Massachusetts General Hospital, Boston, for 24 years. His roles included Director of the Depression Clinical and Research Program and Associate Chief of Psychiatry. Dr. Alpert has received numerous awards for excellence in teaching and mentorship, scholarship, and patient care, and has authored more than 220 publications. His academic interests include treatment-resistant depression, treatment of depression with comorbid conditions, mental health disparities, ethical issues in research design, and medical education.

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