Depression in the Gastroenterology Unit : Its clincial feartures and pathophysiological mechanisms(Depression in Varied Clinical Fielda-The current conditions and points of consideration)

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  • 消化器領域におけるうつ病の実態と留意点(各科領域におけるうつ病の実態と留意点)(第33回日本心身医学会総会)
  • 各科領域におけるうつ病の実態と留意点 　消化器領域におけるうつの実態と留意点
  • 消化器領域におけるうつの実態と留意点
  • ショウカキ リョウイキ ニ オケル ウツ ノ ジッタイ ト リュウイテン

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Abstract

The number of depressive patients who predominantly complain of physical symptoms rather than typical psychiatric ones has been recently increasing. According to our recent survey, 14.6% of all outpatients visiting our clinic were diagnosed as having depression. Among physical complaints of those depressive patients, gastrointestinal symptoms ranked the highest (63%) in incidence, followed by cardiovascular (20%) and pulmonary (14%) ones. Although the mechanism by which digestive symptoms develop in many depressive patients is still poorly understood, we have recently observed that gallbladder contractility in response to caerulein injection is impaired in those depressive patients, thereby suggesting that biliary diskinesia may be involved in the development of abdominal symptoms in depression. On the other hand, a number of digestive diseases such as peptic ulcer, achalasia, chronic pancreatitis and malignant tumors often accompany depression. Particularly, special attention should be paid to pancreatic cancer. For the past 15 years or so, we have found 21 cases with malignant cancer in the digestive tract who had been treated as depression in other medical institutions, out of whom 13 patients had pancreatic cancer. This figure would be surprisingly high even if we take into consideration the fact that early diagnosis of pancreatic cancer is still difficult. To clarify this intriguing problem, we have been conducting various immunoneuroendocrine studies, leading to the hypothesis that cytokines including interleukin-1 produced by cancer cells in the pancreas may affect the central nervous system, thereby inducing depressive state possibly through a mechanism mediated by corticotropin-releasing factor in the brain. Finally, we described here several useful points in the diagnosis and management of depressive patients who tend to visit general physicians. We emphasized that every clinician should bear in mind that he or she has a good chance to see depressive patients in the outpatient clinic regardless of his or her specialty and that he or she is accordingly required to manage these patients adequately and properly.

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