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Abstract
BACKGROUND Depression is associated with an increased risk of mortality in patients with coronary heart disease. There is evidence that this risk may be reduced in patients who respond to depression treatment. The purpose of this study was to determine whether cardiac risk markers predict poor response to depression treatment and, second, whether they improve with successful treatment. METHODS One hundred fifty-seven patients with stable coronary heart disease who met the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for a moderate to severe major depressive episode were treated with cognitive behavior therapy, either alone or combined with an antidepressant, for up to 16 weeks. Depression, physical activity, sleep quality, thyroid hormones (total thyroxine [T4] and free T4), and inflammatory blood markers (C-reactive protein, interleukin-6, tumor necrosis factor) were assessed at baseline and after 16 weeks of treatment. RESULTS The mean (SD) Beck Depression Inventory scores were 30.2 (8.5) at baseline and 8.5 (7.8) at 16 weeks. More than 50% of the participants met the criteria for depression remission (17-item Hamilton Rating Scale for Depression ≤ 7) at 16 weeks. Only free T4 thyroid hormone at baseline predicted poor response to depression treatment after adjustment for potential confounders (p = .004). Improvement in sleep quality (p = .012) and physical activity level (p = .041) correlated with improvement in depression. None of the inflammatory markers predicted posttreatment depression or changed with depression. CONCLUSIONS Thyroid hormone (T4) level predicted depression treatment outcome, and improvement in depression correlated with improvement in sleep and physical activity. More detailed studies of thyroid function and objective assessments of sleep and physical activity in relation to depression improvement and cardiac outcomes are needed.
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Aksay SS, Bumb JM, Janke C, Biemann R, Borucki K, Lederbogen F, Deuschle M, Sartorius A, Kranaster L. Serum lipid profile changes after successful treatment with electroconvulsive therapy in major depression: A prospective pilot trial. J Affect Disord 2016; 189:85-8. [PMID: 26426831 DOI: 10.1016/j.jad.2015.09.037] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 07/20/2015] [Accepted: 09/20/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Cholesterol is reduced in depressed patients, however, these patients have a higher risk for cardiovascular diseases. Electroconvulsive therapy (ECT) is a highly effective treatment option for specific forms of depression. Like for other non-pharmacological therapies targeting depression such as psychotherapy or sleep deprivation, there is a lack of evidence about the effects on peripheral lipid parameters. Our objective was to study the impact of ECT as a non-pharmacological treatment on the peripheral lipid pattern in depressive patients. METHOD Peripheral lipid profile composition before and after a course of ECT was analysed in 27 non-fasting inpatients at a university psychiatric hospital with DSM-IV major depressive episode. For the impact of ECT treatment on each lipid parameter a multivariate repeated measurement regression analysis was performed and computed separately for every dependent variable. RESULTS Total Cholesterol and the cholesterol subtypes HDL and LDL were increased after the treatment compared to baseline. Apolipoprotein A1 was also increased after ECT, whereas apolipoprotein B was not. Indices for the prediction of cardiovascular diseases were unchanged after successful treatment by ECT. The reduction of depressive psychopathology negatively correlated with increases of HDL cholesterol and apolipoprotein A1. LIMITATIONS Subjects received several antidepressants and other psychotropic medication before and during the ECT. CONCLUSIONS In our preliminary pilot study ECT as a non-pharmacological, effective treatment of depression led to distinct effects on the peripheral lipid pattern.
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Affiliation(s)
- Suna Su Aksay
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Jan Malte Bumb
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Christoph Janke
- Department of Anesthesiology and Critical Care Medicine, Medical Centre Mannheim, Mannheim, Germany
| | - Ronald Biemann
- Institute of Clinical Chemistry and Pathobiochemistry, Otto-von-Guericke-University, Magdeburg, Germany
| | - Katrin Borucki
- Institute of Clinical Chemistry and Pathobiochemistry, Otto-von-Guericke-University, Magdeburg, Germany
| | - Florian Lederbogen
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Michael Deuschle
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Alexander Sartorius
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Laura Kranaster
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany.
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Granville Smith I, Parker G, Rourke P, Cvejic E, Vollmer-Conna U. Acute coronary syndrome and depression: A review of shared pathophysiological pathways. Aust N Z J Psychiatry 2015. [PMID: 26219293 DOI: 10.1177/0004867415597304] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To examine the evidence for shared pathophysiological pathways in acute coronary syndrome and major depression and to conceptualise the dynamic interplay of biological systems and signalling pathways that link acute coronary syndrome and depression within a framework of neuro-visceral integration. METHODS Relevant articles were sourced via a search of published literature from MEDLINE, EMBASE and PubMed using a variety of search terms relating to biological connections between acute coronary syndrome and depression. Additional articles from bibliographies of retrieved papers were assessed and included where relevant. RESULTS Despite considerable research efforts, a clear understanding of the biological processes connecting acute coronary syndrome and depression has not been achieved. Shared abnormalities are evident across the immune, platelet/endothelial and autonomic/stress-response systems. From the available evidence, it seems unlikely that a single explanatory model could account for the complex interactions of biological pathways driving the pathophysiology of these disorders and their comorbidity. CONCLUSION A broader conceptual framework of mind-body or neuro-visceral integration that can incorporate the existence of several causative scenarios may be more useful in directing future research and treatment approaches for acute coronary syndrome-associated depression.
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Affiliation(s)
- Isabelle Granville Smith
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Gordon Parker
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Poppy Rourke
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Erin Cvejic
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Uté Vollmer-Conna
- School of Psychiatry, Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
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Castelpietra G, Gobbato M, Valent F, Bovenzi M, Barbone F, Clagnan E, Pascolo-Fabrici E, Balestrieri M, Isacsson G. Somatic disorders and antidepressant use in suicides: A population-based study from the Friuli Venezia Giulia region, Italy, 2003-2013. J Psychosom Res 2015; 79:372-7. [PMID: 26526311 DOI: 10.1016/j.jpsychores.2015.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 09/20/2015] [Accepted: 09/21/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Many somatic disorders are complicated by depression and increase the risk of suicide. Little is known about whether antidepressants might reduce the suicidal risk in patients with somatic disorders. METHODS Data on diagnoses and antidepressant prescriptions were derived from the Social and Health Information System of the Friuli Venezia Giulia Region. Cases were all suicides that occurred in the region during the years 2003-2013 and were sex- and age-matched to controls from the general population. Conditional logistic regression analysis was used to assess the association between suicide and somatic disorders. RESULTS The suicide rate in Friuli Venezia Giulia decreased from 11.3 to 10.7 per 100,000 inhabitants during the years 2003-2013, however patients with somatic disorder had a three times increased risk of suicide. Elderly somatic patients' suicide risk was twice as high as younger patients. The risk increased from 2.6 to 9.8 times as the number of comorbid disorders increased from 1 to 4 and over. Although no significant risk of suicide in patients with somatic disorders was found when patients were adherent to antidepressants, only 11.5% of the suicides was adherent in the year prior to death. CONCLUSIONS Medical illnesses and underlying depressive symptoms may have a synergy effect on the risk of suicide, particularly in older patients and in patients with multiple morbidities. Since medically ill subjects adherent to antidepressants did not show a significant risk of suicide, early identification and adequate treatment of depression in somatic patients should be considered in order to prevent suicide.
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Affiliation(s)
- Giulio Castelpietra
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden; Central Health Directorate/Classification Area, Friuli Venezia Giulia Region, Italian Collaborating Centre for the WHO Family of International Classifications, Udine, Italy.
| | - Michele Gobbato
- Epidemiological Service, Regional Health Directorate, Friuli Venezia Giulia Region, Udine, Italy.
| | - Francesca Valent
- Epidemiological Service, Regional Health Directorate, Friuli Venezia Giulia Region, Udine, Italy.
| | - Massimo Bovenzi
- Department of Medical Sciences, University of Trieste, Trieste, Italy.
| | - Fabio Barbone
- Department of Medical Sciences, University of Trieste, Trieste, Italy; Department of Medical and Biological Sciences, University of Udine, Udine, Italy.
| | - Elena Clagnan
- Epidemiological Service, Regional Health Directorate, Friuli Venezia Giulia Region, Udine, Italy.
| | | | - Matteo Balestrieri
- Department of Experimental and Clinical Medical Sciences, University of Udine, Udine, Italy.
| | - Göran Isacsson
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
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Whang W, Davidson KW, Palmeri NO, Bhatt AB, Peacock J, Chaplin WF, Shimbo D, Edmondson DE. Relations among depressive symptoms, electrocardiographic hypertrophy, and cardiac events in non-ST elevation acute coronary syndrome patients. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2015; 5:455-60. [PMID: 26450780 DOI: 10.1177/2048872615610736] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 09/08/2015] [Indexed: 01/04/2023]
Abstract
AIMS Cardiac outcomes after acute coronary syndrome (ACS) are worse in patients with depression, but identifying which depressed patients are at increased risk, and by what means, remains difficult. METHODS AND RESULTS We analyzed inpatient electrocardiograms (ECGs) from 955 patients admitted with non-ST elevation ACS (NSTE-ACS) in the Prescription Use, Lifestyle, and Stress Evaluation (PULSE) study. Patients with QRS duration ⩾120 ms or whose rhythm was not normal sinus were excluded (sample size=769). Depressive symptoms were measured by Beck Depression Inventory score ⩾10. ECG markers included Cornell product-left ventricular hypertrophy (CP-LVH) and strain pattern in the lateral leads. In multivariable logistic regression models, depressive symptoms were associated with increased odds of CP-LVH, ECG-strain, and the combination of the two (odds ratios 1.74-2.33, p values <0.01). The combination of both CP-LVH and ECG-strain was predictive of one-year risk of myocardial infarction (MI) or death among patients with depressive symptoms (hazard ratio 4.91, 95% CI 1.55-15.61, p=0.007), but not among those without depressive symptoms (p value for interaction 0.043). CONCLUSION In our non-ST elevation (NSTE)-ACS cohort, ECG markers of hypertrophy were both more common, and more predictive of MI/mortality, among those with depressive symptoms. Cardiac hypertrophy is a potential target for therapy to improve outcomes among depressed NSTE-ACS patients.
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Affiliation(s)
- William Whang
- Department of Medicine, Columbia University Medical Center, USA
| | | | | | - Anupama B Bhatt
- Department of Medicine, Columbia University Medical Center, USA
| | - James Peacock
- Department of Medicine, Columbia University Medical Center, USA
| | | | - Daichi Shimbo
- Department of Medicine, Columbia University Medical Center, USA
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Depression Symptom Severity and Cardiorespiratory Fitness in Healthy and Depressed Adults: A Systematic Review and Meta-Analysis. Sports Med 2015; 46:219-30. [DOI: 10.1007/s40279-015-0409-5] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Depression and cardiovascular disease. Trends Cardiovasc Med 2015; 25:614-22. [DOI: 10.1016/j.tcm.2015.02.002] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 02/04/2015] [Accepted: 02/04/2015] [Indexed: 01/17/2023]
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Acute coronary syndrome-associated depression: the salience of a sickness response analogy? Brain Behav Immun 2015; 49:18-24. [PMID: 25746589 DOI: 10.1016/j.bbi.2015.02.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 02/09/2015] [Accepted: 02/23/2015] [Indexed: 12/12/2022] Open
Abstract
Depression emerging in conjunction with acute coronary syndrome (ACS) is thought to constitute a distinct high-risk phenotype with inflammatory determinants. This review critically examines the notion put forward in the literature that ACS-associated depression constitutes a meaningful subtype that is qualitatively different from depressive syndromes observed in psychiatric patients; and evaluates the salience of an analogy to the acute sickness response to infection or injury as an explanatory model. Specific features differentiating ACS-associated depression from other phenotypes are discussed, including differences in depression symptom profiles, timing of the depressive episode in relation to ACS, severity of the cardiac event, and associated immune activation. While an acute sickness response analogy offers a plausible conceptual framework, concrete evidence is lacking for inflammatory activity as the triggering mechanism. It is likely that ACS-associated depression encompasses several causative scenarios.
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Jani BD, Purves D, Barry SJE, McCowan C, Cavanagh J, Mair FS. The effects of anti-depressants on depression symptom scores at 12 months follow-up in patients with cardiometabolic disease: Results from a large primary care cohort. J Family Med Prim Care 2015; 4:373-9. [PMID: 26286616 PMCID: PMC4535098 DOI: 10.4103/2249-4863.161324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Evidence on the long-term usefulness of anti-depressants in managing depression in cardiometabolic disease is limited. Aim: We examined the effects of anti-depressant prescribing on depressive symptoms at 12 months follow-up in patients with cardiometabolic disease and a positive depression screening result at baseline. Design and Setting: We retrospectively reviewed routine UK primary care data for patients with coronary heart disease, diabetes and previous stroke for the year 2008–2009. 35,537 patients with one of the three above diseases underwent depression screening using the Hospital Anxiety and Depression Scale (HADS-D). Of 7080 patients with a positive screening result (HADS-D ≥ 8), 3933 (55.5%) patients had a repeat HADS-D recorded at 12 months follow-up. Methods: We compared the change in HADS-D at follow-up and remission rate in those who were prescribed anti-depressants (n = 223) against those who were not (n = 3710). Results: The mean change in HADS-D from baseline, for the nonprescribed group was similar to the reduction observed in patients who were continuously prescribed (n = 93) with anti-depressants during follow-up. Patients who were prescribed intermittently (n = 72) or only one (n = 58) prescription during follow-up had a lower reduction in HADS-D compared to the nonprescribed group. There was no difference in remission rates between continuously prescribed and the nonprescribed group, but remission was lower in patients prescribed intermittently and single prescription. Conclusion: Improvement in depressive symptoms in patients with cardiometabolic disease at 12 months was not any better in patients prescribed with anti-depressants compared to the nonprescribed group. The role of anti-depressants in the management of depression in cardiometabolic disease merits further investigation.
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Affiliation(s)
- Bhautesh Dinesh Jani
- General Practice and Primary Care, Sackler Institute, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Southern General Hospital, University of Glasgow, Glasgow, United Kingdom
| | - David Purves
- Robertson Centre for Biostatistics, Sackler Institute, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Southern General Hospital, University of Glasgow, Glasgow, United Kingdom
| | - Sarah J E Barry
- Robertson Centre for Biostatistics, Sackler Institute, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Southern General Hospital, University of Glasgow, Glasgow, United Kingdom
| | - Colin McCowan
- Robertson Centre for Biostatistics, Sackler Institute, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Southern General Hospital, University of Glasgow, Glasgow, United Kingdom
| | - Jonathan Cavanagh
- Mental Health and Wellbeing, Sackler Institute, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Southern General Hospital, University of Glasgow, Glasgow, United Kingdom
| | - Frances S Mair
- General Practice and Primary Care, Sackler Institute, Institute of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, Southern General Hospital, University of Glasgow, Glasgow, United Kingdom
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Kang HJ, Stewart R, Bae KY, Kim SW, Shin IS, Hong YJ, Ahn Y, Jeong MH, Yoon JS, Kim JM. Predictors of depressive disorder following acute coronary syndrome: Results from K-DEPACS and EsDEPACS. J Affect Disord 2015; 181:1-8. [PMID: 25913538 DOI: 10.1016/j.jad.2015.04.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 04/02/2015] [Accepted: 04/02/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Depression is common and associated with poor prognosis in acute coronary syndrome (ACS). There are few reports on the predictors of incident and persistent post-discharge depressive disorders in ACS. This study aimed to investigate the incidence and persistence of depressive disorder over a one year follow-up, and predictors of these outcomes. METHODS 1152 patients with recently developed ACS were recruited at baseline, and 828 were followed one year thereafter. Depressive disorder (major and minor) was diagnosed according to DSM-IV criteria, and analyzed according to baseline prevalence, and follow up incidence and persistence. Of 446 baseline participants with depressive disorders, 300 were randomized to a 24-week double blind trial of escitalopram or placebo, while the remaining 146 received medical treatment as usual. Associations of baseline socio-demographic and clinical characteristics with depressive disorder were investigated using logistic regression models. RESULTS Two-week prevalence, and one-year incidence and persistence of depressive disorder were 38.7%, 13.1%, and 46.3%, respectively. Baseline depressive disorder was independently associated with female, lower educational level, previous ACS and higher heart rate. Incident depressive disorder was independently predicted by current unemployment, family history of depression, higher baseline Hamilton Depression Rating Scale(HAMD) score and lower left ventricular ejection fraction, and persistent depressive disorder by higher baseline HAMD score and the placebo or medical treatment as usual group in the 24-week trial. LIMITATIONS The generalizability should be considered since this study conducted in a single center. CONCLUSIONS Depressive disorder in ACS patients is common and often persistent, and is associated with baseline characteristics and insufficient treatment. Appropriate detection and treatment of depressive disorder are clearly important in ACS patients.
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Affiliation(s)
- Hee-Ju Kang
- Departments of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Robert Stewart
- King׳s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Kyung-Yeol Bae
- Departments of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sung-Wan Kim
- Departments of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Il-Seon Shin
- Departments of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Young Joon Hong
- Departments of Cardiology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Youngkeun Ahn
- Departments of Cardiology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Myung Ho Jeong
- Departments of Cardiology, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jin-Sang Yoon
- Departments of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jae-Min Kim
- Departments of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea.
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Abstract
Patients with cardiovascular disease (CVD) commonly have syndromal major depression, and depression has been associated with an increased risk of morbidity and mortality. Prevalence of depression is between 17% and 47% in CVD patients. Pharmacologic and psychotherapeutic interventions have long been studied, and in general are safe and somewhat efficacious in decreasing depressive symptoms in patients with CVD. The impact on cardiac outcomes remains unclear. The evidence from randomized controlled clinical trials indicates that antidepressants, especially selective serotonin uptake inhibitors, are overwhelmingly safe, and likely to be effective in the treatment of depression in patients with CVD. This review describes the prevalence of depression in patients with CVD, the physiological links between depression and CVD, the treatment options for affective disorders, and the clinical trials that demonstrate efficacy and safety of antidepressant medications and psychotherapy in this patient population. Great progress has been made in understanding potential mediators between major depressive disorder and CVD—both health behaviors and shared biological risks such as inflammation.
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Affiliation(s)
- Nicole Mavrides
- Department of Psychiatry and Behavioral Sciences, Center on Aging, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Charles B Nemeroff
- Department of Psychiatry and Behavioral Sciences, Center on Aging, University of Miami Miller School of Medicine, Miami, Florida, USA
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Yousofpour M, Kamalinejad M, Esfahani MM, Shams J, Tehrani HH, Bahrami M. Role of Heart and its Diseases in the Etiology of Depression According to Avicenna's Point of View and its Comparison with Views of Classic Medicine. Int J Prev Med 2015; 6:49. [PMID: 26124946 PMCID: PMC4462772 DOI: 10.4103/2008-7802.158178] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 04/21/2015] [Indexed: 11/07/2022] Open
Abstract
Background: Depression is one of the most important medical problems in today's world; despite its high prevalence, its causes unfortunately remain not fully known. Among important issues regarding this is its relation with heart diseases. Based on studies this comorbidity increase morbidity and mortality and leads to worst prognosis. However the cause of such high rate of comorbidity is unclear and instead of efforts to understand this correlation has prompted the medical world to consult other medicinal disciplines, not only to find the answer but also to increase the effectiveness of treatment and decrease its cost. Methods: We first reviewed the most important ancient causes for depression mentioned by Avicenna and considered those as the key words for our next step. Then, we made a literature search (PubMed and Scopus) with those key words to find out new scientific findings in modern medicine about the Avicenna's suggestions. Results: Avicenna does not regard depression as only a mental ailment, but as a disorder resulted by the involvement of brain, heart and blood. He believed that the main causes of depressive events are rooted in heart diseases; in most cases brain is only affected secondary to the heart. Thus he declared that for the treatment of depressive disorders, the underlying cardiovascular diseases should be considered. Conclusions: It is worthwhile to consider the Avicenna's recommended causes of depression and to design future scientific studies based on his suggestions.
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Affiliation(s)
- Mohammad Yousofpour
- Department of Traditional Iranian Medicine, Traditional and Complementary Medicine Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Mohammad Kamalinejad
- Department of Pharmacognosy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Mahdi Esfahani
- Department of Iranian Traditional Medicine, School of Iranian Traditional Medicine, Research Center of Quran, Hadith and Medicine, Tehran, Iran. University of Medical Sciences, Tehran, Iran
| | - Jamal Shams
- Department of Psychiatry, Behavioral Science Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hassan Hoshdar Tehrani
- Department of Pharmacognosy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohsen Bahrami
- Department of Iranian Traditional Medicine, School of Iranian Traditional Medicine, Tehran University of Medical Sciences, Tehran, Iran
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Kim JM, Stewart R, Bae KY, Kang HJ, Kim SW, Shin IS, Hong YJ, Ahn Y, Jeong MH, Yoon JS. Effects of depression co-morbidity and treatment on quality of life in patients with acute coronary syndrome: the Korean depression in ACS (K-DEPACS) and the escitalopram for depression in ACS (EsDEPACS) study. Psychol Med 2015; 45:1641-1652. [PMID: 25412614 DOI: 10.1017/s003329171400275x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Depression is common after acute coronary syndrome (ACS) with adverse effects on prognosis. There is little evidence on whether depression treatment improves quality of life (QoL) in ACS patients. The aim of this study was to investigate the effects of co-morbid depression and its treatment on QoL in ACS. METHOD In total, 1152 patients were recruited at baseline, 2-14 weeks after a confirmed ACS episode, and 828 were followed 1 year thereafter. Of 446 baseline participants with co-morbid depressive disorders, 300 were randomized to a 24-week double blind trial of escitalopram or placebo, while the remaining 146 received medical treatment only (MTO). QoL was measured by the World Health Organization Quality of Life -Abbreviated form (WHOQOL-BREF). RESULTS At baseline, QoL was significantly lower in patients with co-morbid depressive disorder than those without. QoL improvement was significantly greater in those receiving escitalopram than those receiving placebo over the 24-week treatment period. In the 1-year follow-up, the better outcomes associated with escitalopram remained evident against both placebo and MTO. CONCLUSIONS Depression was significantly associated with worse QoL even in patients with recently developed ACS. Depression treatment was associated with QoL improvement in ACS patients in the 24-week treatment period, the effects of which extended to 1 year.
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Affiliation(s)
- J-M Kim
- Department of Psychiatry,Chonnam National University Medical School, andDepression Clinical Research Center,Chonnam National University Hospital,Gwangju,Korea
| | - R Stewart
- Institute of Psychiatry,King's College London,London,UK
| | - K-Y Bae
- Department of Psychiatry,Chonnam National University Medical School, andDepression Clinical Research Center,Chonnam National University Hospital,Gwangju,Korea
| | - H-J Kang
- Department of Psychiatry,Chonnam National University Medical School, andDepression Clinical Research Center,Chonnam National University Hospital,Gwangju,Korea
| | - S-W Kim
- Department of Psychiatry,Chonnam National University Medical School, andDepression Clinical Research Center,Chonnam National University Hospital,Gwangju,Korea
| | - I-S Shin
- Department of Psychiatry,Chonnam National University Medical School, andDepression Clinical Research Center,Chonnam National University Hospital,Gwangju,Korea
| | - Y J Hong
- Department of Cardiology,Chonnam National University Medical School, andDepression Clinical Research Center,Chonnam National University Hospital,Gwangju,Korea
| | - Y Ahn
- Department of Cardiology,Chonnam National University Medical School, andDepression Clinical Research Center,Chonnam National University Hospital,Gwangju,Korea
| | - M H Jeong
- Department of Cardiology,Chonnam National University Medical School, andDepression Clinical Research Center,Chonnam National University Hospital,Gwangju,Korea
| | - J-S Yoon
- Department of Psychiatry,Chonnam National University Medical School, andDepression Clinical Research Center,Chonnam National University Hospital,Gwangju,Korea
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Wardenaar KJ, Wanders RBK, Roest AM, Meijer RR, De Jonge P. What does the beck depression inventory measure in myocardial infarction patients? a psychometric approach using item response theory and person-fit. Int J Methods Psychiatr Res 2015; 24:130-42. [PMID: 25994207 PMCID: PMC6878327 DOI: 10.1002/mpr.1467] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 02/04/2015] [Accepted: 03/17/2015] [Indexed: 11/05/2022] Open
Abstract
Observed associations between depression following myocardial infarction (MI) and adverse cardiac outcomes could be overestimated due to patients' tendency to over report somatic depressive symptoms. This study was aimed to investigate this issue with modern psychometrics, using item response theory (IRT) and person-fit statistics to investigate if the Beck Depression Inventory (BDI) measures depression or something else among MI-patients. An IRT-model was fit to BDI-data of 1135 MI patients. Patients' adherence to this IRT-model was investigated with person-fit statistics. Subgroups of "atypical" (low person-fit) and "prototypical" (high person-fit) responders were identified and compared in terms of item-response patterns, psychiatric diagnoses, socio-demographics and somatic factors. In the IRT model, somatic items had lower thresholds compared to depressive mood/cognition items. Empirically identified "atypical" responders (n = 113) had more depressive mood/cognitions, scored lower on somatic items and more often had a Comprehensive International Diagnostic Interview (CIDI) depressive diagnosis than "prototypical" responders (n = 147). Additionally, "atypical" responders were younger and more likely to smoke. In conclusion, the BDI measures somatic symptoms in most MI patients, but measures depression in a subgroup of patients with atypical response patterns. The presented approach to account for interpersonal differences in item responding could help improve the validity of depression assessments in somatic patients.
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Affiliation(s)
- Klaas J Wardenaar
- University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, Groningen, The Netherlands
| | - Rob B K Wanders
- University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, Groningen, The Netherlands
| | - Annelieke M Roest
- University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, Groningen, The Netherlands
| | - Rob R Meijer
- Department of Psychometrics and Statistics, University of Groningen, Groningen, The Netherlands
| | - Peter De Jonge
- University Medical Center Groningen, Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), University of Groningen, Groningen, The Netherlands
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Cleare A, Pariante CM, Young AH, Anderson IM, Christmas D, Cowen PJ, Dickens C, Ferrier IN, Geddes J, Gilbody S, Haddad PM, Katona C, Lewis G, Malizia A, McAllister-Williams RH, Ramchandani P, Scott J, Taylor D, Uher R. Evidence-based guidelines for treating depressive disorders with antidepressants: A revision of the 2008 British Association for Psychopharmacology guidelines. J Psychopharmacol 2015; 29:459-525. [PMID: 25969470 DOI: 10.1177/0269881115581093] [Citation(s) in RCA: 413] [Impact Index Per Article: 45.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
A revision of the 2008 British Association for Psychopharmacology evidence-based guidelines for treating depressive disorders with antidepressants was undertaken in order to incorporate new evidence and to update the recommendations where appropriate. A consensus meeting involving experts in depressive disorders and their management was held in September 2012. Key areas in treating depression were reviewed and the strength of evidence and clinical implications were considered. The guidelines were then revised after extensive feedback from participants and interested parties. A literature review is provided which identifies the quality of evidence upon which the recommendations are made. These guidelines cover the nature and detection of depressive disorders, acute treatment with antidepressant drugs, choice of drug versus alternative treatment, practical issues in prescribing and management, next-step treatment, relapse prevention, treatment of relapse and stopping treatment. Significant changes since the last guidelines were published in 2008 include the availability of new antidepressant treatment options, improved evidence supporting certain augmentation strategies (drug and non-drug), management of potential long-term side effects, updated guidance for prescribing in elderly and adolescent populations and updated guidance for optimal prescribing. Suggestions for future research priorities are also made.
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Affiliation(s)
- Anthony Cleare
- Professor of Psychopharmacology & Affective Disorders, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Affective Disorders, London, UK
| | - C M Pariante
- Professor of Biological Psychiatry, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Affective Disorders, London, UK
| | - A H Young
- Professor of Psychiatry and Chair of Mood Disorders, King's College London, Institute of Psychiatry, Psychology and Neuroscience, Centre for Affective Disorders, London, UK
| | - I M Anderson
- Professor and Honorary Consultant Psychiatrist, University of Manchester Department of Psychiatry, University of Manchester, Manchester, UK
| | - D Christmas
- Consultant Psychiatrist, Advanced Interventions Service, Ninewells Hospital & Medical School, Dundee, UK
| | - P J Cowen
- Professor of Psychopharmacology, Psychopharmacology Research Unit, Neurosciences Building, University Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - C Dickens
- Professor of Psychological Medicine, University of Exeter Medical School and Devon Partnership Trust, Exeter, UK
| | - I N Ferrier
- Professor of Psychiatry, Honorary Consultant Psychiatrist, School of Neurology, Neurobiology & Psychiatry, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - J Geddes
- Head, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - S Gilbody
- Director of the Mental Health and Addictions Research Group (MHARG), The Hull York Medical School, Department of Health Sciences, University of York, York, UK
| | - P M Haddad
- Consultant Psychiatrist, Cromwell House, Greater Manchester West Mental Health NHS Foundation Trust, Salford, UK
| | - C Katona
- Division of Psychiatry, University College London, London, UK
| | - G Lewis
- Division of Psychiatry, University College London, London, UK
| | - A Malizia
- Consultant in Neuropsychopharmacology and Neuromodulation, North Bristol NHS Trust, Rosa Burden Centre, Southmead Hospital, Bristol, UK
| | - R H McAllister-Williams
- Reader in Clinical Psychopharmacology, Institute of Neuroscience, Newcastle University, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - P Ramchandani
- Reader in Child and Adolescent Psychiatry, Centre for Mental Health, Imperial College London, London, UK
| | - J Scott
- Professor of Psychological Medicine, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - D Taylor
- Professor of Psychopharmacology, King's College London, London, UK
| | - R Uher
- Associate Professor, Canada Research Chair in Early Interventions, Dalhousie University, Department of Psychiatry, Halifax, NS, Canada
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Systematic Review and Individual Patient Data Meta-Analysis of Sex Differences in Depression and Prognosis in Persons With Myocardial Infarction: A MINDMAPS Study. Psychosom Med 2015; 77:419-28. [PMID: 25886829 DOI: 10.1097/psy.0000000000000174] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Using combined individual patient data from prospective studies, we explored sex differences in depression and prognosis post-myocardial infarction (MI) and determined whether disease indices could account for found differences. METHODS Individual patient data analysis of 10,175 MI patients who completed diagnostic interviews or depression questionnaires from 16 prospective studies from the MINDMAPS study was conducted. Multilevel logistic and Cox regression models were used to determine sex differences in prevalence of depression and sex-specific effects of depression on subsequent outcomes. RESULTS Combined interview and questionnaire data from observational studies showed that 36% (635/1760) of women and 29% (1575/5526) of men reported elevated levels of depression (age-adjusted odds ratio = 0.68, 95% confidence interval [CI] = 0.60-0.77). The risk for all-cause mortality associated with depression was higher in men (hazard ratio = 1.38, 95% CI = 1.30-1.47) than in women (hazard ratio = 1.22, 95% CI = 1.14-1.31; sex by depression interaction: p < .001). Low left ventricular ejection fraction (LVEF) was associated with higher depression scores in men only (sex by LVEF interaction: B = 0.294, 95% CI = 0.090-0.498), which attenuated the sex difference in the association between depression and prognosis. CONCLUSIONS The prevalence of depression post-MI was higher in women than in men, but the association between depression and cardiac prognosis was worse for men. LVEF was associated with depression in men only and accounted for the increased risk of all-cause mortality in depressed men versus women, suggesting that depression in men post-MI may, in part, reflect cardiovascular disease severity.
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Banankhah SK, Friedmann E, Thomas S. Effective treatment of depression improves post-myocardial infarction survival. World J Cardiol 2015; 7:215-223. [PMID: 25914790 PMCID: PMC4404376 DOI: 10.4330/wjc.v7.i4.215] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 01/05/2015] [Accepted: 02/09/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To examine the contribution of treatment resistant depression (TRD) to mortality in depressed post-myocardial infarction (MI) patients independent of biological and social predictors.
METHODS: This secondary analysis study utilizes the Enhancing Recovery in Coronary Heart Disease (ENRICHD) clinical trial data. From 1834 depressed patients in the ENRICHD study, there were 770 depressed post-MI patients who were treated for depression. In this study, TRD is defined as having a less than 50% reduction in Hamilton Depression (HAM-D) score from baseline and a HAM-D score of greater than 10 in 6 mo after depression treatment began. Cox regression analysis was used to examine the independent contributions of TRD to mortality after controlling for the biological and social predictors.
RESULTS: TRD occurred in 13.4% (n = 103) of the 770 patients treated for depression. Patients with TRD were significantly younger in age (P = 0.04) (mean = 57.0 years, SD = 11.7) than those without TRD (mean = 59.2 years, SD = 12.0). There was a significantly higher percentage of females with TRD (57.3%) compared to females without TRD (47.4%) [χ2 (1) = 4.65, P = 0.031]. There were significantly more current smokers with TRD (44.7%) than without TRD (33.0%) [χ2 (1) = 7.34, P = 0.007]. There were no significant differences in diabetes (P = 0.120), history of heart failure (P = 0.258), prior MI (P = 0.524), and prior stroke (P = 0.180) between patients with TRD and those without TRD. Mortality was 13% (n = 13) in patients with TRD and 7% (n = 49) in patients without TRD, with a mean follow-up of 29 mo (18 mo minimum and maximum of 4.5 years). TRD was a significant independent predictor of mortality (HR = 1.995; 95%CI: 1.011-3.938, P = 0.046) after controlling for age (HR = 1.036; 95%CI: 1.011-1.061, P = 0.004), diabetes (HR = 2.912; 95%CI: 1.638-5.180, P < 0.001), heart failure (HR = 2.736; 95%CI: 1.551-4.827, P = 0.001), and smoking (HR = 0.502; 95%CI: 0.228-1.105, P = 0.087).
CONCLUSION: The analysis of TRD in the ENRICHD study shows that the effective treatment of depression reduced mortality in depressed post-MI patients. It is important to monitor the effectiveness of depression treatment and change treatments if necessary to reduce depression and improve cardiac outcomes in depressed post-MI patients.
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68
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Franco S, Hoertel N, Peyre H, Rodríguez-Fernández JM, Limosin F, Blanco C. Age at onset of major depression and adulthood cardiovascular risk. Psychiatry Res 2015; 225:736-8. [PMID: 25595335 DOI: 10.1016/j.psychres.2014.12.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 12/08/2014] [Accepted: 12/12/2014] [Indexed: 11/19/2022]
Abstract
Childhood-onset compared to adulthood-onset of major depression is associated with increased rates of serious cardiovascular events, independently of cardiovascular risk factors. This could be explained by a longer duration of exposure to depression. Cardiovascular disease risk should be systematically assessed in individuals with long duration of major depression.
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Affiliation(s)
- Silvia Franco
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, NY 10032, USA.
| | - Nicolas Hoertel
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, NY 10032, USA; Assistance Publique-Hôpitaux de Paris (APHP), Corentin Celton Hospital, Department of Psychiatry, Paris Descartes University, PRES Sorbonne Paris Cité, 92130 Issy-les-Moulineaux, Paris, France; INSERM UMR 894, Psychiatry and Neurosciences Center, Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France
| | - Hugo Peyre
- Assistance Publique Hôpitaux de Paris (APHP), Robert Debré Hospital, Child and Adolescent Psychiatry Department, Paris, France; Cognitive Sciences and Psycholinguistic Laboratory, Ecole Normale Supérieure, CNRS, EHESS, Paris, France
| | | | - Frédéric Limosin
- Assistance Publique-Hôpitaux de Paris (APHP), Corentin Celton Hospital, Department of Psychiatry, Paris Descartes University, PRES Sorbonne Paris Cité, 92130 Issy-les-Moulineaux, Paris, France; INSERM UMR 894, Psychiatry and Neurosciences Center, Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France
| | - Carlos Blanco
- Department of Psychiatry, New York State Psychiatric Institute/Columbia University, New York, NY 10032, USA
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Singh P, Khullar S, Singh M, Kaur G, Mastana S. Diabetes to cardiovascular disease: is depression the potential missing link? Med Hypotheses 2015; 84:370-8. [PMID: 25655224 DOI: 10.1016/j.mehy.2015.01.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 12/12/2014] [Accepted: 01/21/2015] [Indexed: 01/15/2023]
Abstract
The etiopathological consequences of diabetes and its imperative sequels have been explored extensively in the scientific arena of cardiovascular diabetology. Innumerable risk covariates and confounders have been delineated for the primary and secondary prevention of diabetes and cardiovascular diseases (CVD). However, an intricate interaction of depression on them has been largely overlooked. Depression influences and participates in each and every step that worsens the diabetic state for developing cardiovascular complications. The dilemma is that it coexists, remains silent and generally not considered as relevant clinical parameter amenable to intervention. In this review, it is highlighted that depression has strong association and linkages with both diabetes and CVD and it should be considered and diagnosed at every stage of the diabetes to CVD continuum. Careful attention to the diagnosis and management of these disease states would contribute in lessening the CVD burden of the society.
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Affiliation(s)
- Puneetpal Singh
- Department of Human Genetics, Punjabi University, Patiala, India
| | - Shallu Khullar
- Department of Human Genetics, Punjabi University, Patiala, India
| | - Monica Singh
- Department of Human Genetics, Punjabi University, Patiala, India
| | - Gurpreet Kaur
- Department of Human Genetics, Punjabi University, Patiala, India
| | - Sarabjit Mastana
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
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70
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O'Neil A, Taylor B, Hare DL, Sanderson K, Cyril S, Venugopal K, Chan B, Atherton JJ, Hawkes A, Walters DL, Oldenburg B. Long-term efficacy of a tele-health intervention for acute coronary syndrome patients with depression: 12-month results of the MoodCare randomized controlled trial. Eur J Prev Cardiol 2014; 22:1111-20. [PMID: 25159700 DOI: 10.1177/2047487314547655] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Accepted: 07/27/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND Depression is common after a cardiac event; however it often remains untreated. Previously, we reported the efficacy and feasibility of a 6-month tele-health programme (MoodCare), which integrates depression management into a cardiovascular disease (CVD) risk reduction programme for Acute Coronary Syndrome (ACS) patients with low mood. Here, we evaluate the long-term efficacy of the programme at 12-month follow-up. DESIGN A two-arm, parallel, randomized design to compare the long-term effects of 'MoodCare' (n = 61) to usual care (UC) (n = 60) at 12 months. METHOD 121 ACS patients recruited from six hospitals in Victoria and Brisbane, Australia were randomized to a telephone-delivered cognitive behavioural therapy and risk-reduction programme or usual medical care. Mixed-model repeated measurements (MMRM) analysis was applied with results expressed as estimated marginal mean changes in depression and health-related quality of life (HRQOL) outcomes by group. RESULTS After 12 months, treatment effects were observed for those with major depressive disorder (MDD) for PHQ-9 depression (MoodCare: mean score: 6.5; 95% CI: 4.9-8.0 versus UC: 9.3; 95% CI: 7.7-10.9, p = 0.012)) and SF-12 mental health scores (MoodCare: 42.5; 95% CI: 39.8-45.2 versus UC: 36.8; 95% CI: 34.1-39.6, p = 0.005). No beneficial treatment effects were observed in those with no MDD at baseline. CONCLUSION After 12 months, MoodCare was superior to UC for improving mental health outcomes for those with a clinical diagnosis of major depression. Our findings support the implementation of depression-based interventions for cardiac patients with a clinical diagnosis of depression and provide evidence of longer term efficacy to one year.
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Affiliation(s)
- Adrienne O'Neil
- School of Medicine, Deakin University, Victoria, Australia School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Barr Taylor
- Department of Psychiatry, Stanford University, CA, USA
| | - David L Hare
- University of Melbourne and Department of Cardiology, Austin Hospital, Victoria, Australia
| | - Kristy Sanderson
- Menzies Research Institute Tasmania, University of Tasmania, Australia
| | - Sheila Cyril
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | | | - Bianca Chan
- Institute for Safety, Compensation and Recovery Research, Monash University, Victoria, Australia
| | - John J Atherton
- Department of Cardiology, The Royal Brisbane and Women's Hospital, Queensland, Australia Department of Medicine, University of Queensland, Queensland, Australia
| | - Anna Hawkes
- School of Public Health and Social Work, Queensland University of Technology, Queensland, Australia
| | - Darren L Walters
- Department of Cardiology, The Price Charles Hospital, Queensland, Australia
| | - Brian Oldenburg
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia School of Population and Global Health, University of Melbourne, Melbourne
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European guidelines on cardiovascular disease prevention in clinical practice (version 2012) : the fifth joint task force of the European society of cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts). Int J Behav Med 2014; 19:403-88. [PMID: 23093473 DOI: 10.1007/s12529-012-9242-5] [Citation(s) in RCA: 161] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Abstract
OBJECTIVE The association between depression and cardiovascular disease has been well documented but the nature of this relationship continues to be defined. Given the accumulation of epidemiological evidence linking these diseases a number of interventional studies have been undertaken to assess the issue of whether antidepressant treatment in depressed patients with cardiovascular disease improves cardiac outcome. The objective of this paper is to review recent randomised controlled trials on this topic and to explore the implications that these may have for future research in this area. METHOD This review is derived from a MEDLINE search using the search terms 'depressive disorder' and 'cardiovascular diseases'. Only randomised controlled trials published in English with clearly defined methods and interventions are included here. Reference sections from the articles were used to identify additional relevant studies. RESULTS A small number of high quality trials were uncovered which indicated mixed results in terms of the treatment of depression in cardiovascular disease. None indicated a statistically significant difference in cardiac outcome. CONCLUSIONS It is not possible at this time to recommend treatment for depression to reduce cardiovascular risk. However depression remains prevalent in patients with cardiovascular disease and is a treatable cause of morbidity in its own right.
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Ladwig KH, Lederbogen F, Albus C, Angermann C, Borggrefe M, Fischer D, Fritzsche K, Haass M, Jordan J, Jünger J, Kindermann I, Köllner V, Kuhn B, Scherer M, Seyfarth M, Völler H, Waller C, Herrmann-Lingen C. Position paper on the importance of psychosocial factors in cardiology: Update 2013. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2014; 12:Doc09. [PMID: 24808816 PMCID: PMC4012565 DOI: 10.3205/000194] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Indexed: 12/30/2022]
Abstract
Background: The rapid progress of psychosomatic research in cardiology and also the increasing impact of psychosocial issues in the clinical daily routine have prompted the Clinical Commission of the German Heart Society (DGK) to agree to an update of the first state of the art paper on this issue which was originally released in 2008. Methods: The circle of experts was increased, general aspects were implemented and the state of the art was updated. Particular emphasis was dedicated to coronary heart diseases (CHD), heart rhythm diseases and heart failure because to date the evidence-based clinical knowledge is most advanced in these particular areas. Differences between men and women and over the life span were considered in the recommendations as were influences of cognitive capability and the interactive and synergistic impact of classical somatic risk factors on the affective comorbidity in heart disease patients. Results: A IA recommendation (recommendation grade I and evidence grade A) was given for the need to consider psychosocial risk factors in the estimation of coronary risks as etiological and prognostic risk factors. Furthermore, for the recommendation to routinely integrate psychosocial patient management into the care of heart surgery patients because in these patients, comorbid affective disorders (e.g. depression, anxiety and post-traumatic stress disorder) are highly prevalent and often have a malignant prognosis. A IB recommendation was given for the treatment of psychosocial risk factors aiming to prevent the onset of CHD, particularly if the psychosocial risk factor is harmful in itself (e.g. depression) or constrains the treatment of the somatic risk factors. Patients with acute and chronic CHD should be offered anti-depressive medication if these patients suffer from medium to severe states of depression and in this case medication with selective reuptake inhibitors should be given. In the long-term course of treatment with implanted cardioverter defibrillators (ICDs) a subjective health technology assessment is warranted. In particular, the likelihood of affective comorbidities and the onset of psychological crises should be carefully considered. Conclusions: The present state of the art paper presents an update of current empirical evidence in psychocardiology. The paper provides evidence-based recommendations for the integration of psychosocial factors into cardiological practice and highlights areas of high priority. The evidence for estimating the efficiency for psychotherapeutic and psychopharmacological interventions has increased substantially since the first release of the policy document but is, however, still weak. There remains an urgent need to establish curricula for physician competence in psychodiagnosis, communication and referral to ensure that current psychocardiac knowledge is translated into the daily routine.
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Affiliation(s)
- Karl-Heinz Ladwig
- Deutsches Forschungszentrum für Gesundheit und Umwelt, Institut für Epidemiologie-2, Helmholtz-Zentrum München, Neuherberg, Germany ; Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Klinikum Rechts der Isar der TU München, Germany
| | - Florian Lederbogen
- Zentralinstitut für Seelische Gesundheit, Universität Heidelberg, Medizinische Fakultät Mannheim, Germany
| | - Christian Albus
- Klinik und Poliklinik für Psychosomatik und Psychotherapie, Universitätsklinikum Köln, Germany
| | | | - Martin Borggrefe
- I. Medizinische Klinik für Kardiologie, Angiologie, Pneumologie, Internistische Intensivmedizin und Hämostaseologie, Universitätsmedizin Mannheim, Germany
| | - Denise Fischer
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Kurt Fritzsche
- Abteilung für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Freiburg, Germany
| | - Markus Haass
- Innere Medizin II: Kardiologie, Angiologie und Internistische Intensivmedizin, Theresienkrankenhaus und St. Hedwig-Klinik, Mannheim, Germany
| | - Jochen Jordan
- Herz-, Thorax- und Rheumazentrum, Abteilung für Psychokardiologie, Kerckhoff Klinik, Bad Nauheim, Germany
| | - Jana Jünger
- Klinik für Allgemeine Innere Medizin und Psychosomatik, Universität Heidelberg, Germany
| | - Ingrid Kindermann
- Innere Medizin III (Kardiologie/Angiologie und Internistische Intensivmedizin), Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Volker Köllner
- Medizinische Fakultät, Universität des Saarlandes, Blieskastel, Germany
| | - Bernhard Kuhn
- Fachpraxis für Innere Medizin, Kardiologie, Angiologie und Notfallmedizin, Heidelberg, Germany
| | - Martin Scherer
- Institut für Allgemeinmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Melchior Seyfarth
- Medizinische Klinik 3 (Kardiologie), Helios-Klinikum Wuppertal-Herzzentrum, Universität Witten/Herdecke, Wuppertal, Germany
| | - Heinz Völler
- Fachklinik für Innere Medizin, Abteilung Kardiologie, Klinik am See, Rüdersdorf, Germany
| | - Christiane Waller
- Abteilung Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Ulm, Germany
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Arnold SV, Spertus JA, Nallamothu BK. The hostile heart: anger as a trigger for acute cardiovascular events. Eur Heart J 2014; 35:1359-60. [DOI: 10.1093/eurheartj/ehu097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Horne D, Kehler DS, Kaoukis G, Hiebert B, Garcia E, Chapman S, Duhamel TA, Arora RC. Impact of physical activity on depression after cardiac surgery. Can J Cardiol 2014; 29:1649-56. [PMID: 24267805 DOI: 10.1016/j.cjca.2013.09.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 09/04/2013] [Accepted: 09/18/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Physical activity is associated with a lower prevalence of depressive symptoms in cardiac patients. However, the benefits of physical activity on depression perioperatively are unknown. We sought to identify independent parameters associated with depression in patients undergoing cardiac surgery. METHODS Patients awaiting nonemergent cardiac surgery (n = 436) completed the Patient Health Questionnaire-9 (PHQ-9) to quantify depression (PHQ-9 score > 9). Physical activity was assessed with the International Physical Activity Questionnaire (IPAQ-short) and accelerometry. Data collection occurred preoperatively (Q1, n = 436), at hospital discharge (Q2, n = 374), at 3 months (Q3, n = 318), and at 6 months (Q4, n = 342) postoperatively. Patients were categorized as "depression naive", "at risk" or "depressed" preoperatively. Physical inactivity was defined as < 600 metabolic equivalent min/wk. Independent perioperative variables associated with depression were identified with univariate and multivariate logistic regression. RESULTS Depression prevalence from Q1-Q4 was 23%, 37%, 21%, and 23%, respectively. Independent associations with depression were preoperative left ventricular ejection fraction < 50% (Q1, P < 0.05), physical inactivity (Q1, P < 0.05), baseline "at-risk" (Q2, P < 0.05), and baseline "depressed" groups (Q2-Q4, P < 0.05), hospital stay > 7 days (Q2, P < 0.05), postoperative stressful event (Q3 and Q4, P < 0.05), and cardiopulmonary bypass time > 120 minutes (Q4, P = 0.05). Newly depressed patients 6 months postoperatively reported lower IPAQ-short physical activity than depression-free patients (median change, -40 min/wk (interquartile range [IQR], -495 to +255) vs +213 min/wk (IQR, +150 to +830; P < 0.05). CONCLUSIONS Up to 40% of patients are depressed after cardiac surgery. Preoperative depression and postoperative stressful events were the strongest independent associations postoperatively. Physical inactivity was associated with preoperative depression and new depression 6 months postoperatively.
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Affiliation(s)
- David Horne
- Department of Surgery (Cardiac Surgery), University of Manitoba, Winnipeg, Manitoba, Canada
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76
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Effect of collaborative care for depression on risk of cardiovascular events: data from the IMPACT randomized controlled trial. Psychosom Med 2014; 76:29-37. [PMID: 24367124 PMCID: PMC3899245 DOI: 10.1097/psy.0000000000000022] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Although depression is a risk and prognostic factor for cardiovascular disease (CVD), depression trials involving cardiac patients have not observed the anticipated cardiovascular benefits. To test our hypothesis that depression treatment delivered before clinical CVD onset reduces risk of CVD events, we conducted an 8-year follow-up study of the Indiana sites of the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) randomized controlled trial. METHODS Participants were 235 primary care patients 60 years or older with major depression or dysthymia who were randomized to a 12-month collaborative care program involving antidepressants and psychotherapy (85 without and 35 with baseline CVD) or usual care (83 without and 32 with baseline CVD). Hard CVD events (fatal/nonfatal) were identified using electronic medical record and Medicare/Medicaid data. RESULTS A total of 119 patients (51%) had a hard CVD event. As hypothesized, the treatment × baseline CVD interaction was significant (p = .021). IMPACT patients without baseline CVD had a 48% lower risk of an event than did usual care patients (28% versus 47%, hazard ratio = 0.52, 95% confidence interval = 0.31-0.86). The number needed to treat to prevent one event for 5 years was 6.1. The likelihood of an event did not differ between IMPACT and usual care patients with baseline CVD (86% versus 81%, hazard ratio = 1.19, 95% confidence interval, 0.70-2.03). CONCLUSIONS Collaborative depression care delivered before CVD onset halved the excess risk of hard CVD events among older, depressed patients. Our findings raise the possibility that the IMPACT intervention could be used as a CVD primary prevention strategy. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01561105.
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77
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Abstract
Cardiovascular disease (CVD) and depression are common. Patients with CVD have more depression than the general population. Persons with depression are more likely to eventually develop CVD and also have a higher mortality rate than the general population. Patients with CVD, who are also depressed, have a worse outcome than those patients who are not depressed. There is a graded relationship: the more severe the depression, the higher the subsequent risk of mortality and other cardiovascular events. It is possible that depression is only a marker for more severe CVD which so far cannot be detected using our currently available investigations. However, given the increased prevalence of depression in patients with CVD, a causal relationship with either CVD causing more depression or depression causing more CVD and a worse prognosis for CVD is probable. There are many possible pathogenetic mechanisms that have been described, which are plausible and that might well be important. However, whether or not there is a causal relationship, depression is the main driver of quality of life and requires prevention, detection, and management in its own right. Depression after an acute cardiac event is commonly an adjustment disorder than can improve spontaneously with comprehensive cardiac management. Additional management strategies for depressed cardiac patients include cardiac rehabilitation and exercise programmes, general support, cognitive behavioural therapy, antidepressant medication, combined approaches, and probably disease management programmes.
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Affiliation(s)
- David L Hare
- Department of Medicine, University of Melbourne, Heidelberg Vic 3084, Australia Department of Cardiology, Austin Health, Heidelberg Vic 3084, Australia
| | - Samia R Toukhsati
- Department of Cardiology, Austin Health, Heidelberg Vic 3084, Australia
| | - Peter Johansson
- Department of Health and Welfare Studies, Faculty of Health Sciences, University of Linköping, Sweden Department of Cardiology, Linköping University Hospital, S-58185 Linköping, Sweden
| | - Tiny Jaarsma
- Department of Health and Welfare Studies, Faculty of Health Sciences, University of Linköping, Sweden Department of Cardiology, Linköping University Hospital, S-58185 Linköping, Sweden
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78
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Harris J, Heil JS. Managing depression in patients with advanced heart failure awaiting transplantation. Am J Health Syst Pharm 2013; 70:867-73. [PMID: 23640347 DOI: 10.2146/ajhp110738] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The relative merits of various forms of antidepressant therapy in patients with heart failure (HF) are discussed, including disease-specific pharmacokinetic changes and drug-interaction challenges in current or likely future candidates for heart transplantation. SUMMARY There is a growing emphasis on the use of antidepressants in patients with chronic HF, as depression can have a negative impact on HF progression and morbidity and mortality after heart transplants or other invasive cardiac surgery. Evidence from one small study of patients with concomitant end-stage HF and major depression indicated a reduced risk of cardiovascular death in those receiving β-blockers in combination with selective serotonin-reuptake inhibitor (SSRI) therapy. In addition to pharmacokinetic changes caused by HF itself, which can decrease medication absorption and distribution, other issues to consider in the drug selection process include the potential for antidepressants to interact with posttransplant immunosuppressive therapy and the possible effects of antidepressant use on surgical transfusion requirements. The SSRIs are generally recommended as first-line therapies for depressed patients with HF; however, fluvoxamine and fluoxetine should be avoided due to interactions with immunosuppressant agents. If SSRI therapy is not well tolerated or adjunctive therapy is required, bupropion, mirtazapine, venlafaxine, and duloxetine may be suitable alternatives for certain patients. CONCLUSION Key considerations in antidepressant selection in the context of advanced HF include HF-related changes in drug pharmacokinetics that may affect initial dosing or dosage adjustment, possible drug interactions, adverse effects that may potentiate those induced by immunosuppressants added after transplantation, and tolerability issues.
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Affiliation(s)
- Justin Harris
- Temple University Hospital, Philadelphia, PA 19140, USA.
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79
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Abstract
During the past two decades, research in the field of depression and cardiovascular disorders has exploded. Multiple studies have demonstrated that depression is more prevalent in populations with cardiovascular disease, is a robust risk factor for the development of cardiovascular disease in healthy populations, and is predictive of adverse outcomes (such as myocardial infarction and death) among populations with preexisting cardiovascular disease. Mechanistic studies have shown that poor health behaviors, such as physical inactivity, medication nonadherence, and smoking, strongly contribute to this association. Small randomized trials have found that antidepressant therapies may improve cardiac outcomes. Based on this accumulating evidence, the American Heart Association has recommended routine screening for depression in all patients with coronary heart disease. This review examines the key epidemiological literature on depression and cardiovascular disorders and discusses our current understanding of the mechanisms responsible for this association. We also examine current recommendations for screening, diagnosis, and management of depression. We conclude by highlighting new research areas and discussing therapeutic management of depression in patients with cardiovascular disorders.
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Affiliation(s)
- Mary A Whooley
- Department of Medicine, University of California, San Francisco, California 94143, USA.
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80
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Meurs M, Zuidersma M, Dickens C, de Jonge P. Examining the relation between post myocardial infarction depression and cardiovascular prognosis using a validated prediction model for post myocardial mortality. Int J Cardiol 2013; 167:2533-8. [DOI: 10.1016/j.ijcard.2012.06.042] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Revised: 05/21/2012] [Accepted: 06/09/2012] [Indexed: 12/22/2022]
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81
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Self-reported depressive symptoms, diagnosed clinical depression and cardiac morbidity and mortality after myocardial infarction. Int J Cardiol 2013; 167:2775-80. [DOI: 10.1016/j.ijcard.2012.07.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2012] [Revised: 07/07/2012] [Accepted: 07/07/2012] [Indexed: 12/23/2022]
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82
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The relationship between depression, anxiety and cardiovascular disease: findings from the Hertfordshire Cohort Study. J Affect Disord 2013; 150:84-90. [PMID: 23507368 PMCID: PMC3729346 DOI: 10.1016/j.jad.2013.02.026] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 02/08/2013] [Accepted: 02/10/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND Previous studies suggest a link between depression, anxiety and cardiovascular disease (CVD). The aim of the study was to determine the relationship between depressive and anxiety symptoms and CVD in a population based cohort. METHODS In total 1578 men and 1,417 women from the Hertfordshire Cohort Study were assessed for CVD at baseline and after 5.9 ± 1.4 years. Depressive and anxiety symptoms were measured using the HADS scale. RESULTS Baseline HAD-D score, but not HAD-A, was significantly associated with baseline plasma triglycerides, glucose and insulin resistance (men only) and HDL cholesterol (women only). After adjustment for CVD risk factors, higher baseline HAD-D scores were associated with increased odds ratios for CVD (men: 1.162 [95% CI 1.096-1.231]; women: 1.107 [1.038-1.181]). Higher HAD-A scores associated with increased CVD in men only. High HAD-D scores predicted incident CVD (adjusted OR 1.130 [1.034-1.235]), all-cause mortality (adjusted HR 1.081, [1.012-1.154]) and cardiovascular mortality (adjusted HR 1.109 [1.002-1.229]) in men but not in women. LIMITATIONS The use of a self-report measure of depressive and anxiety symptoms, 'healthy' responder bias and the low number of cardiovascular events are all limitations. CONCLUSIONS Depressive and anxiety symptoms are commoner in people with CVD. These symptoms are independent predictors of CVD in men. Although HAD-D score was significantly associated with several cardiovascular risk factors, this did not fully explain the association between HAD-D and CVD.
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83
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Meijer A, Conradi HJ, Bos EH, Anselmino M, Carney RM, Denollet J, Doyle F, Freedland KE, Grace SL, Hosseini SH, Lane DA, Pilote L, Parakh K, Rafanelli C, Sato H, Steeds RP, Welin C, de Jonge P. Adjusted prognostic association of depression following myocardial infarction with mortality and cardiovascular events: individual patient data meta-analysis. Br J Psychiatry 2013; 203:90-102. [PMID: 23908341 DOI: 10.1192/bjp.bp.112.111195] [Citation(s) in RCA: 135] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND The association between depression after myocardial infarction and increased risk of mortality and cardiac morbidity may be due to cardiac disease severity. AIMS To combine original data from studies on the association between post-infarction depression and prognosis into one database, and to investigate to what extent such depression predicts prognosis independently of disease severity. METHOD An individual patient data meta-analysis of studies was conducted using multilevel, multivariable Cox regression analyses. RESULTS Sixteen studies participated, creating a database of 10 175 post-infarction cases. Hazard ratios for post-infarction depression were 1.32 (95% CI 1.26-1.38, P<0.001) for all-cause mortality and 1.19 (95% CI 1.14-1.24, P<0.001) for cardiovascular events. Hazard ratios adjusted for disease severity were attenuated by 28% and 25% respectively. CONCLUSIONS The association between depression following myocardial infarction and prognosis is attenuated after adjustment for cardiac disease severity. Still, depression remains independently associated with prognosis, with a 22% increased risk of all-cause mortality and a 13% increased risk of cardiovascular events per standard deviation in depression z-score.
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Affiliation(s)
- A Meijer
- Interdisciplinary Centre for Psychiatric Epidemiology, University Medical Centre Groningen, Groningen, The Netherlands
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84
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Meurs M, Zuidersma M, de Jonge P. Reply to: “Is a score of 10 or greater on the Beck Depression Inventory equivalent to clinically diagnosed depression?”. Int J Cardiol 2013. [DOI: 10.1016/j.ijcard.2012.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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85
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Rahman I, Humphreys K, Bennet AM, Ingelsson E, Pedersen NL, Magnusson PKE. Clinical depression, antidepressant use and risk of future cardiovascular disease. Eur J Epidemiol 2013; 28:589-95. [PMID: 23836399 DOI: 10.1007/s10654-013-9821-z] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 06/27/2013] [Indexed: 01/20/2023]
Abstract
Many studies have shown that depression contributes to a higher risk of developing cardiovascular disease (CVD). Use of antidepressants and its association with CVD development has also been investigated previously but the results have been conflicting. Further, depression and use of antidepressants have been more widely studied in relation to coronary heart disease rather than stroke. A population-based cohort study consisting of 36,654 Swedish elderly twins was conducted with a follow-up of maximum 4 years. Information on exposures, outcomes and covariates were collected from the Swedish national patient registers, the Swedish prescribed drug registry and the Swedish twin registry. Depression and antidepressant use were both associated with CVD development. The risk was most pronounced among depressed patients who did not use antidepressants (HR 1. 48, CI 1.10-2.00). When assessing the two main CVD outcomes coronary heart disease and ischemic stroke separately, the predominant association was found for ischemic stroke while it was absent for coronary heart disease. The association between depression and stroke also remained significant when restricting to depression diagnoses occurring at least 10 years before baseline. The study supports that depression is a possible risk factor for development of CVD. Moreover, the hazard rate for CVD outcomes was highest among depressed patients who had not used antidepressants. The association with clinical depression is more marked in relation to stroke and disappears in relation to development of coronary heart disease.
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Affiliation(s)
- Iffat Rahman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, 17177, Stockholm, Sweden.
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86
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Roest AM, Carney RM, Freedland KE, Martens EJ, Denollet J, de Jonge P. Changes in cognitive versus somatic symptoms of depression and event-free survival following acute myocardial infarction in the Enhancing Recovery In Coronary Heart Disease (ENRICHD) study. J Affect Disord 2013; 149:335-41. [PMID: 23489396 PMCID: PMC3672326 DOI: 10.1016/j.jad.2013.02.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 02/07/2013] [Accepted: 02/07/2013] [Indexed: 01/19/2023]
Abstract
BACKGROUND Randomized controlled trials focusing on the effects of antidepressant treatment in cardiac patients have found modest effects on depressive symptoms but not on cardiac outcomes. A secondary analysis was conducted on data from the Enhancing Recovery in Coronary Heart Disease trial to assess whether changes in somatic or cognitive depressive symptoms following acute MI predicted event-free survival and whether the results differed per treatment arm (cognitive behavior therapy or care as usual). METHODS Patients who met depression criteria and completed the 6th month depression assessment (n=1254) were included in this study. Measurements included demographic and clinical data and the Beck Depression Inventory at baseline and 6 months. The primary endpoint was a composite of recurrent MI and mortality over 2.4 years (standard deviation=0.9 years). RESULTS Positive changes (per 1 point increase) in somatic depressive symptoms (HR: 0.95; 95% CI: 0.92-0.98; p=0.001) but not in cognitive depressive symptoms (HR: 0.98; 95% CI: 0.96-1.01; p=0.19) were related to a reduced risk of recurrent MI and mortality after adjustment for baseline depression scores. There was a trend for an interaction effect between changes in somatic depressive symptoms and the intervention (p=0.08). After controlling for demographic and clinical variables, the association between changes in somatic depressive symptoms and event-free survival remained significant in the intervention arm (HR: 0.93; 95% CI: 0.88-0.98; p=0.01) only. LIMITATIONS Secondary analyses. CONCLUSIONS Changes in somatic depressive symptoms, and not cognitive symptoms, were related to improved outcomes in the intervention arm, independent of demographic and clinical variables.
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Affiliation(s)
- Annelieke M Roest
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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87
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Acharya T, Acharya S, Tringali S, Huang J. Association of antidepressant and atypical antipsychotic use with cardiovascular events and mortality in a veteran population. Pharmacotherapy 2013; 33:1053-61. [PMID: 23776095 DOI: 10.1002/phar.1311] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
STUDY OBJECTIVES To determine the patterns of antidepressant and atypical antipsychotic use in a veteran population with depression, and to determine if an association exists between specific antidepressant classes and atypical antipsychotics and the occurrence of cardiovascular events and all-cause mortality. DESIGN Retrospective, cross-sectional study. SETTING Primary care clinic at a Veterans Affairs hospital. PATIENTS A total of 1136 patients diagnosed with depression who were receiving antidepressant monotherapy (664 patients) or no antidepressant therapy (472 patients [controls]) between June 2009 and December 2010. MEASUREMENTS AND MAIN RESULTS Data on patient demographics, disease diagnoses, laboratory data, and drug therapy profiles were collected through medical record review. Of the 1136 patients, the mean patient age was 61 years, 90% were men, and 77% were smokers. Mean body mass index was 30.4 kg/m(2) , blood pressure 126/73 mm Hg, hemoglobin A1c 6%, low-density lipoprotein cholesterol level 106.7 mg/dl, and Framingham score 17. Patients receiving antidepressant monotherapy were grouped according to antidepressant class; selective serotonin reuptake inhibitors (SSRIs) were most common. Concomitant use of atypical antipsychotics was more common with the serotonin-norepinephrine reuptake inhibitor (venlafaxine), SSRI, and serotonin receptor antagonist (trazodone) classes (p=0.0067). After adjusting for demographics, concomitant drugs, and comorbidities, SSRI use was significantly associated with lower all-cause mortality (odds ratio [OR] 0.37, 95% confidence interval [CI] 0.19-0.71, p=0.0028). Notably, noradrenergic and specific serotonergic antidepressant (mirtazapine) use was significantly associated with higher prevalence of heart failure (OR 3.26, 95% CI 1.029-10.38, p=0.0445). Use of atypical antipsychotics was significantly associated with a higher prevalence of cerebrovascular events (OR 2.23, 95% CI 1.29-3.83, p=0.0036) and all-cause mortality (OR 2.05, 95% CI 1.03-4.1, p=0.04). CONCLUSION Our results favor treatment of depression with SSRIs among patients at increased cardiovascular risk due to the potential mortality benefit of this class of drugs. Atypical antipsychotics should be used with caution in the elderly population. Mirtazapine use in patients with heart failure and depression deserves further investigation.
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Affiliation(s)
- Tushar Acharya
- Primary Care Service, Veterans Administration Central California Health Care System, Fresno, California; Department of Medicine, University of California, San Francisco, Fresno Medical Education Program, Fresno, California
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Gallo JJ, Morales KH, Bogner HR, Raue PJ, Zee J, Bruce ML, Reynolds CF. Long term effect of depression care management on mortality in older adults: follow-up of cluster randomized clinical trial in primary care. BMJ 2013; 346:f2570. [PMID: 23738992 PMCID: PMC3673762 DOI: 10.1136/bmj.f2570] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To investigate whether an intervention to improve treatment of depression in older adults in primary care modified the increased risk of death associated with depression. DESIGN Long term follow-up of multi-site practice randomized controlled trial (PROSPECT-Prevention of Suicide in Primary Care Elderly: Collaborative Trial). SETTING 20 primary care practices in New York City, Philadelphia, and Pittsburgh, USA, randomized to intervention or usual care. PARTICIPANTS 1226 participants identified between May 1999 and August 2001 through a two stage, age stratified (60-74; ≥ 75 years) depression screening of randomly sampled patients; enrollment included patients who screened positive and a random sample of patients who screened negative. INTERVENTION For two years, a depression care manager worked with primary care physicians in intervention practices to provide algorithm based care for depression, offering psychotherapy, increasing antidepressant dose if indicated, and monitoring symptoms, adverse effects of drugs, and adherence to treatment. This paper reports the long term follow-up. MAIN OUTCOME MEASURE Mortality risk based on a median follow-up of 98 (range 0.8-116.4) months through 2008. RESULTS In baseline clinical interviews, 396 people were classified as having major depression, 203 had clinically significant minor depression, and 627 did not meet criteria for depression. At follow-up, 405 patients had died. Patients with major depression in usual care were more likely to die than were those without depression (hazard ratio 1.90, 95% confidence interval 1.57 to 2.31). In contrast, patients with major depression in intervention practices were at no greater risk than were people without depression (hazard ratio 1.09, 0.83 to 1.44). Patients with major depression in intervention practices, relative to usual care, were 24% less likely to have died (hazard ratio 0.76, 0.57 to 1.00; P=0.05). Preliminary data on cause of death are provided. No significant effect on mortality was found for minor depression. CONCLUSIONS Older adults with major depression in practices provided with additional resources to intensively manage depression had a mortality risk lower than that observed in usual care and similar to older adults without depression. TRIAL REGISTRATION Clinical trials NCT00000367.
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Affiliation(s)
- Joseph J Gallo
- Department of Mental Health, Johns Hopkins University Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD 21205, USA
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A meta-analysis of mental health treatments and cardiac rehabilitation for improving clinical outcomes and depression among patients with coronary heart disease. Psychosom Med 2013; 75:335-49. [PMID: 23630306 DOI: 10.1097/psy.0b013e318291d798] [Citation(s) in RCA: 147] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To quantify the efficacy of mental health (antidepressants & psychotherapies) and cardiac rehabilitation treatments for improving secondary event risk and depression among patients with coronary heart disease (CHD). METHODS Using meta-analytic methods, we evaluated mental health and cardiac rehabilitation therapies for a) reducing secondary events and 2) improving depression severity in patients with CHD. Key word searches of PubMed and Psychlit databases and previous reviews identified relevant trials. RESULTS Eighteen mental health trials evaluated secondary events and 22 trials evaluated depression reduction. Cardiac rehabilitation trials for the same categories numbered 17 and 13, respectively. Mental health treatments did not reduce total mortality (absolute risk reduction [ARR] = -0.001, confidence interval [95% CI] = -0.016 to 0.015; number needed to treat [NNT] = ∞), showed moderate efficacy for reducing CHD events (ARR = 0.029, 95% CI = 0.007 to 0.051; NNT = 34), and a medium effect size for improving depression (Cohen d = 0.297). Cardiac rehabilitation showed similar efficacy for treating depression (d = 0.23) and reducing CHD events (ARR = 0.017, 95% CI = 0.007 to 0.026; NNT = 59) and reduced total mortality (ARR = 0.016, 95% CI = 0.005 to 0.027; NNT = 63). CONCLUSIONS Among patients with CHD, mental health treatments and cardiac rehabilitation may each reduce depression and CHD events, whereas cardiac rehabilitation is superior for reducing total mortality risk. The results support a continued role for mental health treatments and a larger role for mental health professionals in cardiac rehabilitation.
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90
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Ziegelstein RC. Improving depression and reducing cardiac events: which is the chicken and which is the egg? J Psychosom Res 2013; 74:454-7. [PMID: 23597336 DOI: 10.1016/j.jpsychores.2013.02.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 02/02/2013] [Accepted: 02/05/2013] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To examine the assumption that depression leads to recurrent cardiac events and death in those with heart disease. METHODS Consideration of alternative perspectives and discussion of the literature. RESULTS It is not clear from studies like MIND-IT, ENRICHD or SADHART whether depression treatment improves cardiac outcomes. In these studies, recurrent cardiac events and death were recorded 6months or more after study entry, but shorter-term cardiac outcomes (e.g., stabilization of plaque prone to rupture and thrombosis or changes in areas of myocardium prone to life-threatening arrhythmia) were not assessed. Although the prevailing view is that shorter-term improvement in depression is necessary to improve cardiovascular outcomes, the possibility that shorter-term improvement in cardiac status might result in reduced symptoms of depression has not been examined. If correct, this possibility might explain why studies have shown that patients whose depression improves also exhibit improved cardiovascular outcomes and lower mortality, even though randomization to the depression intervention in these studies had no effect. CONCLUSION It is not clear whether improving depression comes first and reduced cardiac events follows or whether patients whose cardiac status improves also exhibit improvement in depression. Which is the chicken and which the egg is more than just a philosophical question, since it may affect the direction of future research in this field, and even how we approach the care of patients with heart disease and depression.
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Affiliation(s)
- Roy C Ziegelstein
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21224, USA.
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91
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Cordes J, Lange-Asschenfeldt C, Hiemke C, Kahl KG. [Psychopharmacotherapy in patients with cardiovascular diseases]. Internist (Berl) 2013; 53:1304, 1306-12, 1314. [PMID: 23052329 DOI: 10.1007/s00108-012-3070-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Increased cardiometabolic morbidity and increased overall mortality has been observed in patients with severe mental disorders. Therefore, cardiometabolic safety is an important issue in the treatment of patients with psychiatric disorders, in particular in patients with comorbid cardiometabolic diseases. Frequent adverse side effects include disturbances of lipid and glucose metabolism, body weight changes and alterations of the QTc interval. Dependent on the particular substance used and on factors concerning individual vulnerability, these side effects vary in relative frequency. Therefore, regular monitoring is recommended including ECG. Furthermore, interactions between different medicaments may occur, either leading to enhanced or decreased drug concentrations. Prior to psychopharmacological treatment, proper cardiological treatment is recommended. The management of cardiovascular risks under psychopharmacology requires interdisciplinary cooperation between the cardiologist, general practitioner and psychiatrist.
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Affiliation(s)
- J Cordes
- Klinik und Poliklinik für Psychiatrie und Psychotherapie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Deutschland.
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92
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Abstract
Approximately one out of every five patients with cardiovascular disease (CVD) suffers from major depressive disorder (MDD). Both MDD and depressive symptoms are risk factors for CVD incidence, severity and outcomes. Great progress has been made in understanding potential mediators between MDD and CVD, particularly focusing on health behaviors. Investigators have also made considerable strides in the diagnosis and treatment of depression among patients with CVD. At the same time, many research questions remain. In what settings is depression screening most effective for patients with CVD? What is the optimal screening frequency? Which therapies are safe and effective? How can we better integrate the care of mental health conditions with that of CVD? How do we motivate depressed patients to change health behaviors? What technological tools can we use to improve care for depression? Gaining a more thorough understanding of the links between MDD and heart disease, and how best to diagnose and treat depression among these patients, has the potential to substantially reduce morbidity and mortality from CVD.
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93
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Mavrides N, Nemeroff C. Treatment of depression in cardiovascular disease. Depress Anxiety 2013; 30:328-41. [PMID: 23293051 DOI: 10.1002/da.22051] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 12/06/2012] [Accepted: 12/08/2012] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Depression in patients with Cardiovascular Disease (CVD) is extremely common, with a prevalence of 17-47%, and is associated with increased risk of morbidity and mortality. Treatment of depression has been hypothesized to reduce cardiac mortality. Pharmacologic and psychotherapeutic interventions have been studied and appear to be safe and in some studies effective in reducing depressive symptoms in patients with cardiac disease. The impact on cardiac outcomes remains unclear. This review briefly focuses on the prevalence of depression in patients with CVD, the physiological links between depression and CVD, and largely is concerned with the clinical trials that seek to demonstrate efficacy and safety of antidepressant medications and psychotherapy in this patient population. METHODS PubMed and PsycINFO databases were searched through July 2012. Publications were included if they were in English, a review article, or a clinical trial in the CVD population with comorbid depression. The search was completed with key words of antidepressants, CVD, coronary artery syndrome, SSRIs, depression, treatment of depression, post-MI (where MI is myocardial infarction), major depression, and cardiac disease. Trials were included if the patients were above the age of 18, both male and female genders, and had cardiac comorbidity. No trials were excluded. RESULTS A total of 61 articles and/or book chapters were included. The majority were from North America and Europe. There were 7 clinical trials of tricyclic antidepressants (TCAs), one of TCAs and bupropion, and 10 trials of selective serotonin reuptake inhibitors (SSRIs). We also evaluated five trials involving psychotherapeutic techniques and/or collaborative care. CONCLUSIONS There is considerable evidence from randomized controlled clinical trials that antidepressants, especially SSRIs, are safe in the treatment of major depression in patients with CVD. Although efficacy has been demonstrated in some, but not all, trials for both antidepressants and certain psychotherapies, large, well-powered trials are urgently needed. There are virtually no data available on predictors of antidepressant response in depressed patients with CVD. Whether successful treatment of depression is associated with a reduction in cardiac morbidity and mortality remains unknown.
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Affiliation(s)
- Nicole Mavrides
- Department of Psychiatry and Behavioral Sciences, Center on Aging, Miller School of Medicine, University of Miami, Miami, Florida
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Liu H, Luiten PGM, Eisel ULM, Dejongste MJL, Schoemaker RG. Depression after myocardial infarction: TNF-α-induced alterations of the blood-brain barrier and its putative therapeutic implications. Neurosci Biobehav Rev 2013; 37:561-72. [PMID: 23415700 DOI: 10.1016/j.neubiorev.2013.02.004] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 01/21/2013] [Accepted: 02/05/2013] [Indexed: 01/04/2023]
Abstract
Patients experiencing an acute myocardial infarction (AMI) have a three times higher chance to develop depression. Vice versa, depressive symptoms increase the risk of cardiovascular events. The co-existence of both conditions is associated with substantially worse prognosis. Although the underlying mechanism of the interaction is largely unknown, inflammation is thought to be of pivotal importance. AMI-induced peripheral cytokines release may cause cerebral endothelial leakage and hence induces a neuroinflammatory reaction. The neuroinflammation may persist even long after the initial peripheral inflammation has subsided. Among those selected brain regions that are prone to blood-brain barrier dysfunction, the paraventricular nucleus of the hypothalamus (PVN), a major center for cardiovascular autonomic regulation, is indicated to play a mediating role. Optimal cardiovascular therapy improves cardiovascular prognosis without major effects on depression. By the same token, antidepressant therapy in cardiovascular disease is associated with modest improvement in depressive symptoms, however without improvement in cardiac outcome. The failure of current antidepressants and the growing number of patients suffering from both conditions legitimize the search for better antidepressive therapies, from patients as well as society perspectives. Though we appreciate the mutual character of the interaction between depression and AMI, the present review focuses on the side of AMI induced depression and discusses the role of inflammation, represented by the proinflammatory cytokine TNF-α, as potential underlying mechanism. It is conceivable that inhibition of the inflammatory response post-AMI, through targeted anti-inflammatory pharmacotherapeutical agents may prevent the development of depressive symptoms and ultimately may improve cardiovascular outcomes.
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Affiliation(s)
- Hui Liu
- Department of Molecular Neurobiology, University of Groningen, The Netherlands
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Characteristics of psychological interventions that improve depression in people with coronary heart disease: a systematic review and meta-regression. Psychosom Med 2013; 75:211-21. [PMID: 23324874 DOI: 10.1097/psy.0b013e31827ac009] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Despite previous intervention trials, it is unclear which psychological treatments are most effective for people with coronary heart disease (CHD). We have conducted a systematic review with meta-regression to identify the characteristics of psychological interventions that improve depression and depressive symptoms among people with CHD. METHODS Searches of multiple electronic databases up to March 2012 were conducted, supplemented by hand-searching of identified reviews and citation tracing of eligible studies. Studies were included if they reported a randomized controlled trial of a psychological intervention for people with CHD and included depression as an outcome. Data on main effects and characteristics of interventions were extracted from eligible studies. Standardized mean differences (SMDs) were calculated for each study and pooled using random-effects models. Random-effects multivariate meta-regression was performed to identify treatment characteristics associated with improvements in depression. RESULTS Sixty-four independent treatment comparisons were identified. Psychological interventions improved depression, although the effect was small (SMD=0.18, p<.001). Problem solving (SMD=0.34), general education (SMD=0.19), skills training (SMD=0.25), cognitive-behavioral therapy (CBT; SMD=0.23), and relaxation (SMD=0.15) had small effects on CHD patients who were recruited irrespective of their depression status. Among high-quality trials of depressed CHD patients, only CBT showed significant but small effects (SMD=0.31). When entered into multivariable analysis, no individual treatment component significantly improved depression. CONCLUSIONS CBT and problem solving should be considered for inclusion in future treatment developments and randomized controlled trials. However, the effects are small in magnitude, and there is room to develop new interventions that may be more effective.
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Thombs BD, Roseman M, Coyne JC, de Jonge P, Delisle VC, Arthurs E, Levis B, Ziegelstein RC. Does evidence support the American Heart Association's recommendation to screen patients for depression in cardiovascular care? An updated systematic review. PLoS One 2013; 8:e52654. [PMID: 23308116 PMCID: PMC3538724 DOI: 10.1371/journal.pone.0052654] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 11/20/2012] [Indexed: 11/19/2022] Open
Abstract
Objectives To systematically review evidence on depression screening in coronary heart disease (CHD) by assessing the (1) accuracy of screening tools; (2) effectiveness of treatment; and (3) effect of screening on depression outcomes. Background A 2008 American Heart Association (AHA) Science Advisory recommended routine depression screening in CHD. Methods CINAHL, Cochrane, EMBASE, ISI, MEDLINE, PsycINFO and SCOPUS databases searched through December 2, 2011; manual journal searches; reference lists; citation tracking; trial registries. Included articles (1) compared a depression screening instrument to a depression diagnosis; (2) compared depression treatment to placebo or usual care in a randomized controlled trial (RCT); or (3) assessed the effect of screening on depression outcomes in a RCT. Results There were few examples of screening tools with good sensitivity and specificity using a priori-defined cutoffs in more than one patient sample among 15 screening accuracy studies. Depression treatment with antidepressants or psychotherapy generated modest symptom reductions among post-myocardial infarction (post-MI) and stable CHD patients (N = 6; effect size = 0.20–0.38), but antidepressants did not improve symptoms more than placebo in 2 heart failure (HF) trials. Depression treatment did not improve cardiac outcomes. No RCTs investigated the effects of screening on depression outcomes. Conclusions There is evidence that treatment of depression results in modest improvement in depressive symptoms in post-MI and stable CHD patients, although not in HF patients. There is still no evidence that routine screening for depression improves depression or cardiac outcomes. The AHA Science Advisory on depression screening should be revised to reflect this lack of evidence.
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Affiliation(s)
- Brett D Thombs
- Department of Psychiatry, McGill University, Montréal, Quebéc, Canada.
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Abstract
Considerable progress has been made during the past decade in research on cardiovascular effects of stress. Early-life stressors, such as childhood abuse and early socioeconomic adversity, are linked to increased cardiovascular morbidity in adulthood. Our updated meta-analyses of prospective studies published until 2011 show a 1.5-fold (95% confidence interval 1.2-1.9) increased risk of coronary heart disease among adults experiencing social isolation and a 1.3-fold (1.2-1.5) excess risk for workplace stress; adverse metabolic changes are one of the underlying plausible mechanisms. Stress, anger, and depressed mood can act as acute triggers of major cardiac events; the pooled relative risk of acute coronary syndrome onset being preceded by stress is 2.5 (1.8-3.5) in case-crossover studies. Stress is also implicated in the prognosis of cardiovascular disease and in the development of stress (takotsubo) cardiomyopathy. A major challenge over the next decade is to incorporate stress processes into the mainstream of cardiovascular pathophysiological research and understanding.
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Affiliation(s)
- Andrew Steptoe
- Department of Epidemiology and Public Health, University College London, London, WC1E 6BT, United Kingdom.
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Blumenthal JA. Targeting lifestyle change in patients with depression. J Am Coll Cardiol 2013; 61:631-4. [PMID: 23290546 DOI: 10.1016/j.jacc.2012.11.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 11/08/2012] [Indexed: 11/28/2022]
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Zuidersma M, Conradi HJ, van Melle JP, Ormel J, de Jonge P. Depression treatment after myocardial infarction and long-term risk of subsequent cardiovascular events and mortality: a randomized controlled trial. J Psychosom Res 2013; 74:25-30. [PMID: 23272985 DOI: 10.1016/j.jpsychores.2012.08.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Revised: 08/14/2012] [Accepted: 08/16/2012] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Evaluating the effects of implementing an antidepressant treatment strategy in depressed myocardial infarction (MI)-patients on long-term cardiovascular outcomes and all-cause mortality. METHODS MI-patients were evaluated for the presence of a diagnosis of post-MI depression at 3, 6, 9 and 12months after hospitalization for MI. A total of 331 depressed MI-patients were randomized to intervention or care-as-usual (CAU). Patients randomized to the intervention were offered several antidepressant treatment options including pharmacological and non-pharmacological therapy. Patients randomized to CAU were not given feedback about their depression status. All patients were free to seek depression treatment outside the study, which was monitored. The primary outcome was a combined endpoint of cardiovascular events and cardiac mortality between randomization and 8years later. All-cause mortality was evaluated as secondary endpoint. RESULTS The intervention did not reduce the risk of the primary outcome (HR: 0.97 (95% CI: 0.67-1.40) n=330) or all-cause mortality (HR: 0.74 (95% CI: 0.41-1.33) n=330). Regardless of randomization status, patients who received depression treatment (n=168) had reduced all-cause mortality rates compared to those who did not receive treatment (n=143, HR: 0.52 (95% CI: 0.28-0.97)). CONCLUSION Implementing an antidepressant treatment strategy did not reduce the risk of cardiovascular morbidity and mortality compared to usual care. Receiving depression treatment increased survival. It remains unclear whether this represents a direct treatment effect or is due to unmeasured factors that relate to both receiving depression treatment and mortality, such as patients' intrinsic motivation to care for their health.
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Affiliation(s)
- Marij Zuidersma
- Interdisciplinary Center Psychopathology and Emotion regulation, Department of Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands.
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