Hello, welcome to this video. On this occasion, we will be accompanied by Dr. Juan Carlos Molano, psychiatrist and head of the Mental Health Department of the Fundación Santa Fe de Bogotá. He is going to talk to us about the diagnosis of depression and what are its characteristics when we have a medically ill patient. The first thing to mention is that depression is highly prevalent in the general population. It is estimated that in the world from 10 to 16 percent of the population may experience depression. Obviously, the coexistence of a medical illness, because the relationship is bidirectional between physical health and mental health, causes a higher frequency of depression pictures. This has a lot to do with the patient's coping styles, personality traits, the nature of the disease, if it is something that causes a lot of discomfort or distress, the course, the prognosis of the disease and, of course, the psychosocial support that a patient can have. We see that some pictures of depression can precede major medical illnesses. An example of those is pancreatic cancer, that can appear even up to six months before the presence of depression. But there are other diseases like Huntington's chorea, Alzheimer's disease that may initially present with symptoms of depression. Pain is also an experience that, without a doubt, generates a lot of emotional discomfort and for those reasons I would say that they are reasonable grounds to think that the Coexistence between depression and medical illness is highly prevalent. It is very common that depression in the medically ill patient, not be recognized by different circumstances. One of them is the limitation in time. Primary care general practitioners have little time to make a comprehensive evaluation for the presence of emotional or behavioral symptoms. The second reason is also the area where this type of valuation can be done. But, perhaps, the most frequent thing is that many doctors tend to attribute that the depression is a normal period that patients have, when really what we see are reactions of sadness. Screening for depression is very important. And another reason that we consider fundamental is that 50 percent of the patients who consult primary care having depression, report physical symptoms. Hence the importance of screening. Remember that depression not only has emotional symptoms, but also cognitive behavioral as well as physical symptoms. Many overlap symptoms that appear in both depression and medical illness. I mean something we call as the vegetative symptoms of depression, such as changes in sleep pattern, insomnia, food, also weakness or lack of energy. In the context of the medically ill patient, There may be multiple factors that precipitate the presence of depression. Within them we find lifestyle changes that patients should make. An example of this is the patient with acute myocardial infarction or diabetes. and that you have to change your habits and their lifestyles to healthier behaviors. Another important factor is chronic pain, especially that it does not have proper management. An example of this situation is the oncological or cancer patient, which additionally has metastases. But we also have a group of diseases that can cause disability, loss of autonomy because they present a significant deterioration and here diseases of the field of neurology correspond a lot. Diseases such as Parkinson's disease, Alzheimer's disease, multiple sclerosis, spinal cord injuries, make the patient lose his capacity for autonomy, of moving around and having to need help from other caregivers or family members. It is also important to mention the effects that some drugs used in medicine in the field of oncology, some anti chemotherapeutic. Also, for example, Immunosuppressants that are important in the field of rheumatology or transplants, can cause depressive symptoms. Antihypertensives widely used in general medicine and internal medicine, and I can't ignore those surgeries either that generate complications or alterations in the image or body scheme. Here another important factor also is the psychosocial support that the patient may have and, Obviously, the course and prognosis of disease are reasons that can precipitate a picture of depression. It is very important to treat depression because, clearly, evidence-based, longitudinal studies prospective, show higher morbidity and mortality, a deterioration in quality of life. Patients who have depression and additionally a general medical illness are not adequately adhere to the treatments indicated by their treating physicians and, they even have very unhealthy lifestyle habits. Many of these depressed patients use nicotine, alcohol, sedentary lifestyle, there may even be consumption of other psychoactive substances and not attending properly to the controls that the doctor proposes. But, additionally, it is important to treat depression, because depression is one of the factors of major risk factors for suicidal behavior. When we talk about grief, we are talking about a reaction adaptive, emotional recovery. It is an eminently emotional process that has several phases. It should be mentioned that the duel not only occurs for the death of a loved one, but also because of a situation that dramatically changes the person's life, how can it be a separation, an economic bankruptcy and obviously, the state of health. Grief has several phases that allow that in the case of a patient who has a disease, Accept your diagnosis accept the recommendations of your treating doctor and seek to solve your medical condition in the best way. On the other hand, in the field of depression, multiple factors contribute. Within these are the personality, coping styles. There is also a biological vulnerability. There are factors, too, that have to do with the pathology as such of the medical condition. Usually requires treatment either by psychotherapy or pharmacotherapy. In the case of the duel, usually what is done is a treatment with psychotherapy. So they are two different processes. Having a medical condition can lead to grief, not necessarily a depression, but that is why we must be attentive to signs that have a lot to do with the acceptance of the disease, behavior towards it and active participation in this proposal that the treatment team has. Of course, family support is also essential. Thank you very much Dr Molano, for telling us about the diagnosis of depression when we have a medically ill patie