Iatrogenic comorbidity in mental health

A specific treatment may cause or precipitate lasting adverse effects on the course of illness. Such vulnerabilities, that are subsumed under the definition of “iatrogenic comorbidity”, may manifest themselves during treatment administration and/or after its discontinuation. The changes are persistent and not limited to a short phase, such as in the case of withdrawal reactions. Iatrogenic comorbidity plays an important and yet neglected role in mental health. There are several examples in psychopharmacology: bipolar course induced by antidepressant drugs in depressed patients who presented with allegedly unipolar features; persistent post-withdrawal disorders after long term use of SSRI and/or SNRI; tardive dyskinesia after long term use of antipsychotics. Iatrogenic comorbidity may occur also as a result of failed psychotherapies. It is thus of crucial importance to incorporate treatment history in mental health assessment. The concept of “iatrogenic comorbidity” may demarcate major prognostic and therapeutic differences among patients who otherwise seem to be deceptively similar since they share the same psychiatric diagnosis.