Patten and colleagues found in a large, prospective Canadian community-based study that there was an increased risk of development of major depression in subjects with chronic medical disorders compared with those without such disorders.9 A total of 4% of those with one or more medical conditions versus 2.8% of those without medical conditions developed major depression over a 2-year period.9 Wells and colleagues in the Epidemiologic Catchment Area Study found that respondents suffering from

one or more of eight chronic medical conditions had a 41% increase in the risk of having any recent psychiatric Inhibitors,research,lifescience,medical disorder (depression, anxiety, or substance abuse).10 Von Korff and colleagues have shown that childhood adversity and depression occurring in adolescence to Inhibitors,research,lifescience,medical early adulthood were independent risk factors for development in adulthood of a range of medical disorders, including diabetes, coronary heart disease, asthma, osteoarthritis, epilepsy, and hypertension.11 Studies have suggested that the relationship between depression and diabetes and/or heart disease is bidirectional. A recent meta-analysis of 13 studies that included 6916 subjects

examined whether depression predicted subsequent development Inhibitors,research,lifescience,medical of diabetes.12 This GSK126 in vivo systematic review found that the pooled relative risk (RR) of depression predicting diabetes was 1.60 (95% CI 1.37, 1. 88). 12 This meta-analysis also found 7 studies representing 6414 Inhibitors,research,lifescience,medical subjects that examined whether type 2 diabetes increased the subsequent

risk of depression. There was modest evidence to support the hypotheses that diabetes was a risk factor for subsequent depression [RR = 1.15 (95% CI 1.02, 1.30)]. 12 A recent 5-year prospective study examined factors associated with major depression at 5-year follow-up in approximately 3000 patients with diabetes. Baseline minor and major depression, the number of diabetes symptoms, and having one Inhibitors,research,lifescience,medical or more cardiac procedures during the 5-year follow-up (OR=1.92, 95% CI 1.10, 3.35) were independent predictors of major depression at this 5-year time-point.3 A systematic review found 8 studies that examined the risk of depression for subsequent onset of myocardial infarction. Clinically diagnosed major depressive disorder was identified as an important risk factor for subsequent Bay 11-7085 development of cardiovascular disease (CVD, RR =1.60 [95% CI 1.34, 1.92]).13 Depression following myocardial infarction is also very common, occurring in up to 25% of patients.6,7 Recent data suggests that about half of these patients who developed depression post- MI had recurrent depressive episodes, and half had their first depressive episode post-MI.7 Those with a first episode post-MI had more severe ventricular damage and had shorter duration of depression.