Last month's issue of Psychiatric Annals dealt with the increasing occurrence of hyponatremia in patients receiving psychotropics such as carbamazepine and SSRIs. In fact, as that issue went to press, I had a patient taking oxcarbazepine and being slowly tapered off of an SSRI call complaining of "burning all over," "skin peeling off my arms," and profound fatigue. I sent her to the emergency room stat. No, it wasn't a Stevens- Johnson syndrome as I had feared (I took the call in another city) but her sodium was 1 19!
This issue is concerned with hepatitis C (HCV) infection, which I learned is a developing epidemic that is 11 times more common in patients with serious mental illness than in the general population. Moreover, the only available treatments for HCV, interferon, has about a 30% rate of inducing major depression associated with its use. Depression presents with many symptoms common to HCV, especially profound fatigue. It leads me to wonder how many HCV cases are being diagnosed as depression. R. Jeffrey Goldsmith, MD, who was one of the guest editors for this issue, expands our understanding of the association of HCV with serious mental illness and drug abuse (particularly IV abuse). It also adds to the reality that if you want to treat depression, you had better be an informed physician.
Add this to the association of depression with neurologic and cardiovascular disease (we need to publish issues on both these topics - anyone interested?), and you are potentially enveloped with the overlap of medicine and psychiatry with every depressed patient that you see (I don't exclude other disorders, but depression is so common).
That's the great thing about practicing psychiatry - it just gets more challenging. I love it!