The puzzle of depression and acute coronary syndrome: reviewing the role of acute inflammation

The effect of escitalopram in treating mild to moderate depressive disorder and improving the quality of life in patients undergoing coronary artery bypass grafting - a double-blind randomized clinical trial

Introduction

Chronic depression and anxiety can be a risk factor for coronary aArtery bypass grafting (CABG) and is an emerging factor after coronary artery disease when the patient is admitted to the hospital and after surgery. We aimed to assess the effect of Escitalopram in treating mild to moderate depressive disorder and improving the quality of life in patients undergoing CABG.

Methods

In this randomized clinical trial, 50 patients undergoing CABG referred to Tehran Heart Hospital from January 2021 to May 2021 and were suffering from mild to moderate depression were randomly assigned to one of the two groups of Escitalopram or placebo. The level of depression was assessed based on Beck's depression inventory and the quality-of-life status and its domains were assessed based on the SF-36 questionnaire in 2 groups. Measurements were obtained at baseline and at four and eight weeks after treatment. Chi-square, Fisher's exact, paired, and Wilcoxon tests or ANOVA were used as appropriate.

Results

There was no significant difference between the level of depression between the two study groups at baseline (P=0.312). There was no significant difference between the quality of life and its domains in the two study groups at baseline (P=0.607). However, the most important effect of Escitalopram was reducing depression scores in the intervention group at weeks 4 and 8 after treatment compared to the placebo group (P<0.001). The quality of life and its domains were significantly higher in the Escitalopram group eight weeks after treatment (P=0.004). The amount of drug side effects at 2 and 4 weeks after treatment had no significant difference between the groups (P>0.05).

Conclusion

Escitalopram was effective in treating mild to moderate depressive disorder and improving quality of life in patients undergoing CABG.

Clinical trial registration

https://irct.behdasht.gov.ir/, identifier IRCT20140126016374N2.

Estimating the prevalence of depression in people with acute coronary syndromes: A systematic review and meta-analysis

BACKGROUND

The epidemic of acute coronary syndromes (ACS) poses a great challenge to depression. However, the prevalence of depression among ACS patients has not been fully determined. This meta-analysis aimed to provide an estimation of the global prevalence of depression among ACS patients (ACS depression).

METHODS

Online databases including PubMed, Cochrane Library, Web of Science, and Scopus were searched for all relevant studies that reported the prevalence of ACS depression through March 2023. Pooled prevalence of ACS depression with 95% confidence interval (CI) was estimated by the random-effect model. All statistical analyses were performed using comprehensive meta-analysis software. This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (identifier CRD42023409338).

RESULTS

A total of 28 studies (17 cohort studies, 9 cross-sectional studies, and 2 case-control studies) were included. The overall pooled prevalence of depression in ACS, derived from 28 studies, was 28.5% (95% CI: 0.28-0.29, P = .000, I2 = 99%). 21 included studies showed a prevalence of 20.3% (95% CI: 0.20-0.21, P = .000, I2 = 96%) in men, and the prevalence in women was 13.6% (95% CI: 0.13-0.14, P = .000, I2 = 95%). Subgroup analysis showed the lowest prevalence in Europe (20.7%, 95% CI: 0.20-0.22, P = .000, I2 = 98%); On different diagnostic criteria, the diagnostic and statistical manual of mental disorders (DSM-IV) (36.8%, 95% CI: 0.35-0.38, P = .000, I2 = 96%) has the highest prevalence. In terms of end year of data collection, the prevalence of ACS depression was lower for studies that ended data collection after 2012 (25.7%, 95% CI: 0.25-0.27, P = .000, I2 = 99%) than in studies before 2012 (30%, 95% CI: 0.29-0.31, P = .000, I2 = 98%).

CONCLUSION SUBSECTIONS

This systematic review and meta-analysis suggest high global prevalence of depression among ACS patients, underlining the necessity of more preventive interventions among ACS patients especially in Asian and North American regions.

Targeting Underlying Inflammation in Carcinoma Is Essential for the Resolution of Depressiveness

In modern clinical practice and research on behavioral changes in patients with oncological problems, there are several one-sided approaches to these problems. Strategies for early detection of behavioral changes are considered, but they must take into account the specifics of the localization and phase in the course and treatment of somatic oncological disease. Behavioral changes, in particular, may correlate with systemic proinflammatory changes. In the up-to-date literature, there are a lot of useful pointers on the relationship between carcinoma and inflammation and between depression and inflammation. This review is intended to provide an overview of these similar underlying inflammatory disturbances in both oncological disease and depression. The specificities of acute and chronic inflammation are considered as a basis for causal current and future therapies. Modern therapeutic oncology protocols may also cause transient behavioral changes, so assessment of the quality, quantity, and duration of behavioral symptoms is necessary to prescribe adequate therapy. Conversely, antidepressant properties could be used to ameliorate inflammation. We will attempt to provide some impetus and present some unconventional potential treatment targets related to inflammation. It is certain that only an integrative oncology approach is justifiable in modern patient treatment.

Severity of psychological distress over five years differs as a function of sex and presence of coronary artery disease

BACKGROUND

Psychological distress is more prevalent and severe among patients with coronary artery disease (CAD) compared to healthy individuals. Little is known regarding its time course, and whether these differences extend to individuals with non-cardiovascular (CV) illnesses. This study examined the presence, severity, and time course of psychological distress in men and women with CAD and those of similarly aged individuals suffering from non-CV conditions.

METHODS

1229 individuals (61% men; mean_age = 60.4 ± 7.0 years) with stable CAD or non-CV illnesses reported on social support, hostility, stress, anxiety and depression at baseline as well as 4.8 ± 0.8 years later. Analyses involved mixed (Sex*CAD status*Time) repeated measures analyses (controlling for relevant covariates), as well as Chi-square and McNemar analyses.

RESULTS

Women with CAD reported more symptoms of depression compared to other participants at both evaluations (p's < 0.01), and reported more symptoms of anxiety and stress compared to others at T1 (p's < 0.05). At T2, perceived stress remained significantly greater among women with CAD compared to men (p's < 0.01), though differences in anxiety were no longer significant. Men reported more hostility than women (p = 0.001). CAD women fell within the clinical range for depression (p < 0.001), anxiety (p = 0.001), and stress (p = 0.030) more frequently compared to others at T1, and for depression (p = 0.009) and stress (p = 0.002) at T2.

CONCLUSIONS

The evolution of patient distress differed as a function of the measure examined, their sex, and/or CV status. While psychological distress was prevalent among these patients with diverse health conditions, women with CAD were particularly and chronically vulnerable.

Experience of depression in older adults with and without a physical long-term condition: findings from a qualitative interview study

OBJECTIVE

To understand how the lived experience of depression differs among patients with a long-term condition (LTC) compared with those without an LTC, and how the experience differs across different types of LTC.

DESIGN

Face-to-face, semistructured interviews.

SETTING

Primary care; General Practitioner (GP) surgeries in and around North London.

PARTICIPANTS

41 primary care patients with depression were recruited. Our sample comprised participants aged 55-75 years with depression only (n=12), depression and coronary heart disease (n=5), depression and type 2 diabetes (n=10) and depression and arthritis (n=14).

RESULTS

Interviews were conducted, audio recorded, transcribed and analysed using thematic analysis. The results revealed that the cardinal diagnostic symptoms of depression (anhedonia, sadness) were experienced by all our participants regardless of LTC. However, the LTC did interact with depression by compounding somatic, cognitive and emotional symptoms, increasing disability and reducing independence, and hindering attempts at coping with mental illness. Our findings demonstrate common experiences across patients as well as key differences based on LTC.

CONCLUSIONS

We suggest four key implications for future care practices of these patients: (1) not all participants with depression and LTC view their mental and physical health as interconnected; there should be allowances in care plans for separate treatment pathways; (2) key features of depression that affect LTC management are social withdrawal and lack of motivation to self-manage or access healthcare; (3) key features of LTCs that worsen depression are pain, the unpredictability of future health and progressive disability; (4) positive self-management of LTC could improve self-efficacy and therefore mood, and should be encouraged.

Psychiatric comorbidity and risk of premature mortality and suicide among those with chronic respiratory diseases, cardiovascular diseases, and diabetes in Sweden: A nationwide matched cohort study of over 1 million patients and their unaffected siblings

BACKGROUND

Persons with noncommunicable diseases have elevated rates of premature mortality. The contribution of psychiatric comorbidity to this is uncertain. We aimed to determine the risks of premature mortality and suicide in people with common noncommunicable diseases, with and without psychiatric disorder comorbidity.

METHODS AND FINDINGS

We used nationwide registries to study all individuals born in Sweden between 1932 and 1995 with inpatient and outpatient diagnoses of chronic respiratory diseases (n = 249,825), cardiovascular diseases (n = 568,818), and diabetes (n = 255,579) for risks of premature mortality (≤age 65 years) and suicide until 31 December 2013. Patients diagnosed with either chronic respiratory diseases, cardiovascular diseases, or diabetes were compared with age and sex-matched population controls (n = 10,345,758) and unaffected biological full siblings (n = 1,119,543). Comorbidity with any psychiatric disorder, and by major psychiatric categories, was examined using diagnoses from patient registers. Associations were quantified using stratified Cox regression models that accounted for time at risk, measured sociodemographic factors, and unmeasured familial confounders via sibling comparisons. Within 5 years of diagnosis, at least 7% (range 7.4% to 10.8%; P < 0.001) of patients with respiratory diseases, cardiovascular diseases, or diabetes (median age at diagnosis: 48 to 54 years) had died from any cause, and 0.3% (0.3% to 0.3%; P < 0.001) had died from suicide, 25% to 32% of people with these medical conditions had co-occurring lifetime diagnoses of any psychiatric disorder, most of which antedated the medical diagnosis. Comorbid psychiatric disorders were associated with higher all-cause mortality (15.4% to 21.1%) when compared to those without such conditions (5.5% to 9.1%). Suicide mortality was also elevated (1.2% to 1.6% in comorbid patients versus 0.1% to 0.1% without comorbidity). When we compared relative risks with siblings without noncommunicable diseases and psychiatric disorders, the comorbidity with any psychiatric disorder was associated with substantially increased mortality rates (adjusted HR range: aHRCR = 7.2 [95% CI: 6.8 to 7.7; P < 0.001] to aHRCV = 8.9 [95% CI: 8.5 to 9.4; P < 0.001]). Notably, comorbid substance use disorders were associated with a higher mortality rate (aHR range: aHRCR = 8.3 [95% CI: 7.6 to 9.1; P < 0.001] to aHRCV = 9.9 [95% CI: 9.3 to 10.6; P < 0.001]) than depression (aHR range: aHRCR = 5.3 [95% CI: 4.7 to 5.9; P < 0.001] to aHRCV = 7.4 [95% CI: 7.0 to 7.9; P < 0.001]), but risks of suicide were similar for these 2 psychiatric comorbidities. One limitation is that we relied on secondary care data to assess psychiatric comorbidities, which may have led to missing some patients with less severe comorbidities. Residual genetic confounding is another limitation, given that biological full siblings share an average of half of their cosegregating genes. However, the reported associations remained large even after adjustment for shared and unmeasured familial confounders.

CONCLUSIONS

In this longitudinal study of over 1 million patients with chronic health diseases, we observed increased risks of all-cause and suicide mortality in individuals with psychiatric comorbidities. Improving assessment, treatment, and follow-up of people with comorbid psychiatric disorders may reduce the risk of mortality in people with chronic noncommunicable diseases.

Hybrid Systematic Review and Network Meta-Analysis of Randomized Controlled Trials of Interventions for Depressive Symptoms in Patients With Coronary Artery Disease

OBJECTIVE

Depression is common in patients with coronary artery disease (CAD) and is associated with poor outcomes. Although different treatments are available, it is unclear which are best or most acceptable to patients, so we conducted a network meta-analysis of evidence from randomized controlled trials (RCTs) of different depression treatments to ascertain relative efficacy.

METHODS

We searched for systematic reviews of RCTs of depression treatments in CAD and updated these with a comprehensive search for recent individual RCTs. RCTs comparing depression treatments (pharmacological, psychotherapeutic, combined pharmacological/psychotherapeutic, exercise, collaborative care) were included. Primary outcomes were acceptability (dropout rate) and change in depressive symptoms 8 week after treatment commencement. Change in 26-week depression and mortality were secondary outcomes. Frequentist, random-effects network meta-analysis was used to synthesize the evidence, and evidence quality was evaluated following Grading of Recommendations, Assessment, Development and Evaluations recommendations.

RESULTS

Thirty-three RCTs (7240 participants) provided analyzable data. All treatments were equally acceptable. At 8 weeks, combination therapy (1 study), exercise (1 study), and antidepressants (10 studies) yielded the strongest effects versus comparators. At 26 weeks, antidepressants were consistently effective, but psychotherapy was only effective versus usual care. There were no differences in treatment groups for mortality. Grading of Recommendations, Assessment, Development and Evaluations ratings ranged from very low to low.

CONCLUSIONS

Overall, the evidence was limited and biased. Although all treatments for post-CAD depression were equally acceptable, antidepressants have the most robust evidence base and should be the first-line treatment. Combinations of antidepressants and psychotherapy, along with exercise, could be more effective than antidepressants alone but require further rigorous, multiarm intervention trials.Systematic Review Registration: CRD42018108293 (International Prospective Register of Systematic Reviews).

Physical Activity Promotes Health and Reduces Cardiovascular Mortality in Depressed Populations: A Literature Overview

Major depression is associated with premature mortality, largely explained by heightened cardiovascular burden. This narrative review summarizes secondary literature (i.e., reviews and meta-analyses) on this topic, considering physical exercise as a potential tool to counteract this alarming phenomenon. Compared to healthy controls, individuals with depression consistently present heightened cardiovascular risk, including "classical" risk factors and dysregulation of pertinent homeostatic systems (immune system, hypothalamic-pituitary-adrenal axis and autonomic nervous system). Ultimately, both genetic background and behavioral abnormalities contribute to explain the link between depression and cardiovascular mortality. Physical inactivity is particularly common in depressed populations and may represent an elective therapeutic target to address premature mortality. Exercise-based interventions, in fact, have proven effective reducing cardiovascular risk and mortality through different mechanisms, although evidence still needs to be replicated in depressed populations. Notably, exercise also directly improves depressive symptoms. Despite its potential, however, exercise remains under-prescribed to depressed individuals. Public health may be the ideal setting to develop and disseminate initiatives that promote the prescription and delivery of exercise-based interventions, with a particular focus on their cost-effectiveness.

Assessing dietary and lifestyle risk behaviours and their associations with disease comorbidities among patients with depression: A case-control study from Bahrain

OBJECTIVES

In Western populations, patients with depression die 10-25 years prematurely compared to controls, mainly due to lifestyle-related diseases. Tobacco smoking, excessive alcohol intake, poor diets and physical inactivity are among the major contributors to disease comorbidities. The objective of this research is to assess the dietary and lifestyle behaviours for Bahraini patients with depression and to determine their associations with different medical comorbidities.

METHODS

A case-control study was conducted from March to December 2019. A sample of 96 diagnosed patients with depression was recruited from the Psychiatric Hospital/Bahrain, and 96 age- and sex-matched controls were recruited from primary health centres. Assessment of anthropometrics, dietary and alcohol intakes, tobacco smoking and physical activity levels were undertaken for both cases and controls. National electronic medical records were reviewed retrospectively for medical comorbidities for the recruited cases. Logistic regression analysis was used to identify associations between lifestyle behaviours and medical comorbidities after controlling for confounding factors.

RESULTS

Patients with depression reported higher intakes of energy and energy-yielding macronutrients (e.g., carbohydrates, protein, and fat); three-fold higher rates of tobacco smoking; and significantly lower levels of physical activity. Cases appeared to be at a doubled risk for developing obesity, diabetes type 2, hypertension, and musculoskeletal disorders. The risk for cardiovascular problems was similar for cases and controls.

CONCLUSIONS

Poor dietary intakes, increased prevalence of smoking, and low levels of physical activity were evident in patients with depression in Bahrain; these factors were associated with some medical comorbidities.

Selected psychological comorbidities in coronary heart disease: Challenges and grand opportunities

Evidence of popular interest in the interrelationships between mind, body, and heart disease dates to Ancient Grecian times and paved the way for modern-day scientific inquiry into the relationships between psychological comorbidities in coronary heart disease. Although the systematic evidence has suggested an association of poor medical prognosis and lower quality of life among patients with coronary heart disease with comorbid psychological conditions, the mechanisms are less well understood. In this selective review article, the epidemiology, mechanisms, screening, and treatment recommendations for 4 common psychological conditions (depression, anxiety, stress, and insomnia) comorbid with coronary heart disease are presented. We focus on the grand challenges and unprecedented opportunities for research in this area considering the methodological and technological innovations of the 21st century. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Randomized controlled trial of a well-being intervention in cardiac patients

OBJECTIVE

Positive psychological well-being interventions have demonstrated promise in improving both psychological and physical health-related outcomes in patients with coronary artery disease (CAD), but evidence of the efficacy of these interventions with individuals with CAD is limited. As such, we developed an eight-week group-based intervention targeting eudaimonic aspects of psychological well-being in a randomized pilot trial. The primary aims of the trial were feasibility and acceptability, and we also explored the intervention's effectiveness on psychological outcomes.

METHOD

Participants were 40 CAD outpatients randomly assigned to the intervention (n = 20) or an attention-matched control group (n = 20). Feasibility was measured by rates of group session attendance and homework completion, and acceptability was assessed through participant ratings of intervention activities. Additional study outcomes, compared between groups, included psychological well-being, optimism, depression, and positive and negative affect.

RESULTS

The intervention met a priori criteria for feasibility and acceptability. The intervention was also associated with greater improvements in psychological well-being (β = -16.90; 95% Confidence Interval [CI] = -23.36, -10.44; p < .001, ES = 1.65), optimism (β = -8.80; 95% CI = -11.17, -6.43; t = -7.41; p < .001; ES = 2.34), and depression (β = 26.45; 95% CI = 20.97, 31.93; p < .001) immediately post-intervention, with sustained effects six weeks later.

CONCLUSIONS

These results indicate that the intervention was feasible, well-accepted, and effective in improving clinically relevant psychological outcomes in individuals with CAD. Future work should seek to replicate this work and assess general health-related and cardiac health-specific outcomes.

Assessing cachexia in older patients: Different definitions - But which one is the most practical for clinical routine?

OBJECTIVE

Patients with chronic inflammatory diseases and malignant tumors have an increased risk of cachexia. No consistent definition exists to rapidly identify cachexia in older patients with and without cancer.

METHODS

One-hundred patients (53% male) aged 70 +  years were included in the study by a university hospital. In addition to the detection of malnutrition and determination of body composition by bioelectrical impedance analysis, cachexia was assessed according to the well-established definitions of Evans (weight loss ≥ 5% within the last 12 months plus additional clinical parameters), Fearon (weight loss > 5% in 6 months) and Bozzetti (weight loss ≥ 10% of habitual weight). After a follow-up of 3.5 years, the mortality rate was recorded.

RESULTS

Thirty-three patients had a malignant tumor disease. The patients with a non-malignant underlying disease did not differ in their mental state, physical condition and state of health compared to patients with cancer. A higher percentage of patients with underlying malignancy had cachexia. There were significant differences in the body composition between the patients with or without cachexia. Cachectic patients exhibited a significantly lower skeletal muscle mass and fat mass. The risk of death was increased in cachectic patients of all three cachexia definitions.

CONCLUSION

For clinical daily routine, the assessments by a weight loss according to Fearon and Bozzetti are suggested to be practicable methods to detect cachexia in older patients with and without cancer.

The association between depressive and sleep symptoms for predicting incident disease onset after 6-year follow-up: findings from the English Longitudinal Study of Ageing

BACKGROUND

The independent effects of depressive symptoms and sleep problems for future physical illness risk have yet to be studied systematically across a variety of disease endpoints.

METHODS

We analysed data from 7395 participants (65.81 ± 9.39 years; 54.8% female) from the English Longitudinal Study of Ageing (ELSA). Baseline was wave 4 and participants were followed up for 6 years until wave 7. Sleep was measured using an adapted version of the Jenkins Sleep Problems questionnaire and depressive symptoms using the Centre for Epidemiological Studies Depression scale. Participants with the illness of interest at baseline [coronary heart disease (CHD), cancer, diabetes/high blood glucose, arthritis] were excluded from models predicting the onset of that illness at follow-up. Logistic regression was used, entering depressive symptoms and sleep problems simultaneously into models controlling for a wide range of covariates.

RESULTS

In fully adjusted models depressive symptoms predicted incident CHD (OR 1.11, 95% CI 1.04-1.20, p = 0.004) and diabetes/high blood glucose (OR 1.13, 95% CI 1.04-1.22, p = 0.002) independent of sleep problems; both depressive symptoms (OR 1.10, 95% CI 1.04-1.16, p = 0.002) and sleep problems (OR 1.14, 95% CI 1.02-1.26, p = 0.019) predicted incident arthritis.

CONCLUSIONS

Sleep problems and depressive symptoms, and a combination of both, were differentially associated with physical illness onset 6 years later. Our findings highlight the importance of taking into account somatic and affective experiences when looking across a variety of different physical illnesses.

High platelet-to-lymphocyte ratio are associated with post-stroke depression

BACKGROUND

Post-stroke depression (PSD) is the most common psychological consequence among stroke patients, and inflammatory cytokines have cited as risk factors in PSD. We aimed to evaluate the predictive value of stratification of PLR (platelet-to-lymphocyte ratio), an inflammatory marker, in PSD patients.

METHODS

A total of 363 acute ischemic stroke (AIS) patients were screened in the study and received 1-month follow-up. All of the patients were categorized into equal tertiles according to the number of patients and the distribution of PLR. PSD status was evaluated by 17-item Hamilton Depression Rating Scale at 1 month after stroke RESULTS: The optimal cut-off points of PLR were: (T1) 42.15-99.60, (T2) 99.72-127.92, (T3) 127.93-259.84. A total of 77 patients (21.2%) were diagnosed with PSD at 1-month follow-up. Significant differences were found between the PSD and non-PSD groups in PLR tertiles of patients (P < 0.001). After adjustment for conventional confounding factors, the odds ratio of PSD was 5.154 (95% CI, 1.933-13.739) for the highest tertile of PLR compared with the lowest tertile. In multiple-adjusted spline regression, continuously PLR showed linear relation with PSD risk after 95 (P < 0.001 for linearity).

LIMITATIONS

We excluded patients with severe aphasia or serious conditions. In addition, the PLR was recorded only at admission, which limited us explore the correlation of the change of PLR over time with PSD CONCLUSIONS: Increased PLR at admission is a significant and independent biomarker to predict the development of PSD, and stratified PLR could strengthen the predictive power for PSD patients.

Spanish adaptation of the Dimensional Anhedonia Rating Scale (DARS)

BACKGROUND

Anhedonia is defined as the lack of enjoyment, engagement in, or energy for life's experiences. Only two scales to measure anhedonia have been adapted for use in Spanish-speaking populations. The aim of this study was to determine the reliability and validity of the Dimensional Anhedonia Rating Scale (DARS) following translation and adaptation for Spanish population.

METHOD

The study sample included 134 patients over 18 years of age with a range of psychiatric diagnoses. Those with substance use, decompensated medical conditions, illiteracy, or lack of fluency in Spanish were excluded. The structure of the Spanish adaptation was evaluated through factor analysis. Internal reliability was assessed through Cronbach's alpha and validity was measured using Pearson's correlation between total scores for DARS and its subscales and SHAPS score.

RESULTS

A strong internal consistency was observed (Cronbach alpha = 0.92 for total scale score and 0.91-0.92 for subscale scores). Similarly, a significant and strong correlation between total scores for DARS and SHAPS was found (r = 0.51, p < 0.01).

LIMITATIONS

The heterogeneous distribution of diagnoses included in the study may limit our results.

CONCLUSIONS

The Spanish DARS maintains the psychometric properties of the original questionnaire, with strong internal consistency and adequate validity. DARS is a specific questionnaire for evaluating anhedonia, incorporating elements that reflect motivation, interest, and effort, and one which offers possible advantages over other anhedonia scales.

Depressive symptoms predict incident chronic disease burden 10 years later: Findings from the English Longitudinal Study of Ageing (ELSA)

OBJECTIVE

To assess the association between depressive symptoms and incident chronic illness burden in prospective longitudinal analyses.

METHODS

We analysed data from 2472 participants (62.88 ± 8.49 years old; 50.8% female) from the English Longitudinal Study of Ageing (ELSA). Depressive symptoms were measured using the Centre for Epidemiological Studies Depression (CES-D) scale at baseline in 2004, and participants were followed up for 10 years. Participants with prevalent illness at baseline (coronary heart disease [CHD], other cardiac illness, stroke, cancer, diabetes/high blood glucose, arthritis, lung disease, osteoporosis and Parkinson's disease) were excluded from models predicting illness burden (the sum of illnesses reported) over follow-up. Linear regression was used controlling for a wide range of covariates.

RESULTS

The mean chronic illness burden was 0.57, with 43.1% experiencing at least one incident physical illness. Baseline continuous CES-D score was a significant predictor of incident chronic illness burden up to 10 years later (incident rate ratio = 1.05, 95% confidence intervals = 0.05-0.21, p = .003), independent of sociodemographic, behavioural, cognitive and clinical covariates. Sensitivity analyses excluding participants who developed a chronic illness within the 2 years following baseline corroborated the main results.

CONCLUSION

Depressive symptoms were associated with greater incident chronic illness burden 10 years later. These findings have clinical implications for the treatment of depression in physically healthy older adults.

Anti-inflammatory treatment and risk of depression in 91,842 patients with acute coronary syndrome and 91,860 individuals without acute coronary syndrome in Denmark

BACKGROUND

We examined if treatment with acetylsalicylic acid (ASA), non-steroid anti-inflammatory drugs (NSAID), or statins after acute coronary syndrome (ACS) are associated with decreased risk of depression.

METHOD

This register-based cohort study included all individuals with a first-time hospital admissions with an ACS diagnosis registered between January 2001 to December 2009 (N=91,842) and a comparable reference population without ACS (N=91,860). Information of ASA, NSAID, and statin use were retrieved from a national prescription register. The study population was followed for hospitalization with depression or receiving prescription of antidepressant medication for up to one year after ACS or study entry (early depression) or one to twelve years after ACS or study entry (late depression).

RESULTS

ASA use after ACS was associated with decreased risk of early depression with hazard ratios (HR) of 0.89 (95% confidence interval 0.85-0.93) but not with late depression 0.96 (0.90-1.01). The corresponding HRs for statin were 0.90 (0.86-0.94) and 0.86 (0.82-0.90). In the non-ACS population, statin use was not associated with neither early nor late depression (HRs 1.04 (0.96-1.12) and 1.00 (0.95-1.06)), while ASA was associated with increased risk of late (HR 1.09 (1.04-1.14)) but not early depression (HR 1.03 (0.97-1.09)). In both populations, NSAID use was associated with increased risk of late but not early depression.

CONCLUSION

Use of ASA or statins were associated with decreased risk of depression in ACS patients but not in individuals without ACS, while use of NSAID was associated with increased risk of late depression in both populations.

Inverted items and validity: A psychobiological evaluation of two measures of psychological resources and one depression scale

Psychological resources and risk factors influence risk of coronary heart disease. We evaluated whether inverted items in the Self-esteem, Mastery, and Center for Epidemiological Studies Depression scales compromise validity in the context of coronary heart disease. In a population-based sample, validity was investigated by calculating correlations with other scales (n = 1004) and interleukin-6 (n = 374), and by analyzing the relationship with 8-year coronary heart disease risk (n = 1000). Negative items did not affect the validity of the resource scales. In contrast, positive items from Center for Epidemiological Studies Depression showed no significant relationships with biological variables. However, they had no major impact on the validity of the original scale.

Chaihulonggumulitang Shows Psycho-cardiology Therapeutic Effects on Acute Myocardial Infarction by Enhancing Bone Marrow Mesenchymal Stem Cells Mobilization

Ischemic myocardium initiates the mobilization and homing of bone marrow mesenchymal stem cells (BM-MSCs) to promote myocardial regeneration after acute myocardial infarction (AMI). Inflammation caused by necrotic cardiomyocytes induce major pathological changes (cardiac remodeling and myocardial apoptosis) as well as anxiety disorder. This process may be inhibited by the differentiation and paracrine effects of BM-MSCs. However, the spontaneous mobilization of BMSCs is insufficient to prevent this effect. Given the anti-inflammatory effects of BM-MSCs, ventricular remodeling and anxiety following AMI, methods focused on enhancing BMSCs mobilization are promising. BFG is a classical traditional Chinese prescription medicine and has been proved effective in treating AMI and reducing anxiety, but the potential mechanism of its function remains unknown. In the present study, we explored the effects of Chaihulonggumulitang (BFG) on AMI and anxiety in vivo and in vitro. We also tested its effects in promoting BMSCs mobilization and alleviating inflammation. Our data showed that the classical Chinese prescription BFG promoted BM-MSCs mobilization, inhibited inflammatory response, and improved heart damage and anxiety developed from AMI. Thus, we provided an underlying mechanism of BFG function in psycho-cardiology conditions such as AMI.

Prophylactic antidepressant treatment following acute coronary syndrome: A systematic review of randomized controlled trials

Major depressive disorder is significantly increased in patients following acute coronary syndrome resulting in twofold increased mortality compared with patients without depression. The depression diagnosis is often missed leading to considerable undertreatment. This systematic review assesses the current evidence of primary prophylactic treatment of depression in patients after acute coronary syndrome. The study protocol was prospectively registered at PROSPERO (registration number CRD42015025587). A systematic review were conducted and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Embase, PsychINFO, CINAHL, and Cochran Library was searched. Two independent reviewers screened the records. The inclusion criteria were randomized controlled trials on adult patients with acute coronary syndrome treated prophylactically with an antidepressant intervention of any kind. A validated assessment tool should measure depression and depressive symptoms. Languages were limited to articles written in English. Six articles were included. Four studies utilized different components of case and disease management, health coaching, or relaxational audiotapes as intervention compared with usual care or with no formal program of rehabilitation. None of the studies showed any significant prophylactic effect against depression. One study with a program of health education and counselling and another study with a pharmacological antidepressant showed significant prophylactic effect on depression and depressive symptoms. All six included studies were associated with high risk of bias. There is not strong evidence of the effects of any type of routine antidepressant prophylaxis in patients following acute coronary syndrome. Further high quality studies are warranted.

Major Depression and Acute Coronary Syndrome-Related Factors

Background

Major Depressive Disorder (MDD) is one of the most common mental illnesses in psychiatry, being considered a risk factor for Acute Coronary Syndrome (ACS).

Objective

To assess the prevalence of MDD in ACS patients, as well as to analyze associated factors through the interdependence of sociodemographic, lifestyle and clinical variables.

Methods

Observational, descriptive, cross-sectional, case-series study conducted on patients hospitalized consecutively at the coronary units of three public hospitals in the city of Rio de Janeiro over a 24-month period. All participants answered a standardized questionnaire requesting sociodemographic, lifestyle and clinical data, as well as a structured diagnostic interview for the DSM-IV regarding ongoing major depressive episodes. A general log-linear model of multivariate analysis was employed to assess association and interdependence with a significance level of 5%.

Results

Analysis of 356 patients (229 men), with an average and median age of 60 years (SD ± 11.42, 27-89). We found an MDD point prevalence of 23%, and a significant association between MDD and gender, marital status, sedentary lifestyle, Killip classification, and MDD history. Controlling for gender, we found a statistically significant association between MDD and gender, age ≤ 60 years, sedentary lifestyle and MDD history. The log-linear model identified the variables MDD history, gender, sedentary lifestyle, and age ≤ 60 years as having the greatest association with MDD.

Conclusion

Distinct approaches are required to diagnose and treat MDD in young women with ACS, history of MDD, sedentary lifestyle, and who are not in stable relationships.

A combined high-sugar and high-saturated-fat dietary pattern is associated with more depressive symptoms in a multi-ethnic population: the HELIUS (Healthy Life in an Urban Setting) study

OBJECTIVE

To identify a high-sugar (HS) dietary pattern, a high-saturated-fat (HF) dietary pattern and a combined high-sugar and high-saturated-fat (HSHF) dietary pattern and to explore if these dietary patterns are associated with depressive symptoms.

DESIGN

We used data from the HELIUS (Healthy Life in an Urban Setting) study and included 4969 individuals aged 18-70 years. Diet was assessed using four ethnic-specific FFQ. Dietary patterns were derived using reduced rank regression with mono- and disaccharides, saturated fat and total fat as response variables. The nine-item Patient Health Questionnaire (PHQ-9) was used to assess depressive symptoms by using continuous scores and depressed mood (identified using the cut-off point: PHQ-9 sum score ≥10).

SETTING

The Netherlands.

RESULTS

Three dietary patterns were identified; an HSHF dietary pattern (including chocolates, red meat, added sugars, high-fat dairy products, fried foods, creamy sauces), an HS dietary pattern (including sugar-sweetened beverages, added sugars, fruit (juices)) and an HF dietary pattern (including high-fat dairy products, butter). When comparing extreme quartiles, consumption of an HSHF dietary pattern was associated with more depressive symptoms (Q1 v. Q4: β=0·18, 95 % CI 0·07, 0·30, P=0·001) and with higher odds of depressed mood (Q1 v. Q4: OR=2·36, 95 % CI 1·19, 4·66, P=0·014). No associations were found between consumption of the remaining dietary patterns and depressive symptoms.

CONCLUSIONS

Higher consumption of an HSHF dietary pattern is associated with more depressive symptoms and with depressed mood. Our findings reinforce the idea that the focus should be on dietary patterns that are high in both sugar and saturated fat.

The Dietary Inflammatory Index, shift work, and depression: Results from NHANES

OBJECTIVES

Abnormal physiology (e.g., inflammation), brought on by environmental exposures (e.g., diet or shift work [SW]), can affect numerous bodily systems, including the brain, and may be associated with depressive symptomatology. The study examined the associations between SW and depressive symptoms and diet-related inflammation (estimated by the Dietary Inflammatory Index [DII]) and depressive symptoms. Additionally, diet was examined as a mediator between SW and depressive symptoms.

METHOD

Data were obtained from the U.S. National Health and Nutrition Examination Survey (Centers for Disease Control and Prevention, 2013). SW data were based on self-report. Dietary data were collected using 24-hr dietary recalls for DII calculation. Depressive symptoms were defined using a cut-point of 10 (moderate) on the Patient Health Questionnaire-9 (PHQ-9). Logistic regression was used to estimate odds ratios and 95% confidence intervals (95% CI) for depressive symptoms by SW and DII quartiles.

RESULTS

DII scores were associated with depressive symptoms among women. Women in DII quartile 4 were 30% more likely to report depressive symptoms than women in quartile 1 (95% CI [1.00-1.68]). There was no association between symptoms and SW when using a PHQ-9 cut-point of 10. When using a cut-point of 5 (mild depressive symptoms), those working any form of SW were more likely to suffer from mild symptoms than day workers (odds ratio = 1.22; 95% CI [1.04-1.43]). There was some evidence for mediation by the DII between SW and depressive symptoms.

CONCLUSIONS

Future longitudinal studies should examine effects of reductions in inflammation through diet on depressive symptoms, especially among shift workers, to elucidate the role of diet on depression among these groups. (PsycINFO Database Record

Kidney dysfunction, systemic inflammation and mental well-being in elderly post-myocardial infarction patients

Background

The aim was to investigate whether mild kidney dysfunction and low-grade inflammation in post-myocardial infarction patients are independently associated with markers of mental well-being (i.e. depressive and apathy symptoms, and dispositional optimism).

Methods

In post-myocardial infarction patients, kidney function was assessed by estimated glomerular filtration rate (eGFR) calculated from the combined CKD-EPI formula based on serum levels of both creatinine and cystatine C. Systemic inflammation was assessed using high sensitivity C-reactive protein (hs-CRP) levels. The 15-item Geriatric Depression Scale (GDS-15), the 3-item apathy subscale and the 4-item optimism questionnaire (4Q) were used to measure mental well-being and were analyzed using linear multivariable regression analysis.

Results

Of the 2355 patients, mean age was 72.3 (range 63–84) years and 80.1% were men. After multivariable adjustment, a poorer kidney function was associated with more depressive symptoms (β = -0.084, p < 0.001), more apathy symptoms (β = -0.101, p < 0.001), and less dispositional optimism (β = 0.072, p = 0.002). Moreover, higher levels of hs-CRP were associated with more depressive symptoms (β = 0.051, p = 0.013), more apathy symptoms (β = 0.083, p < 0.001) and less dispositional optimism (β = -0.047 p = 0.024). Apathy showed the strongest independent relation with both low eGFR and high hs-CRP.

Conclusions

In post-myocardial infarction patients, impaired kidney function and systemic inflammation showed a stronger association with apathy than with depressive symptoms and dispositional optimism.

Relationship between interleukin-1β and depressive disorder after acute coronary syndrome

This study was aimed to investigate the effect of serum interleukin (IL)-1β in the depression trajectory after acute coronary syndrome (ACS) considering two IL-1β polymorphisms: -511C/T or +3953C/T. A total of 969 patients were evaluated within 2weeks after ACS and of these, 711 were followed-up 1year later. Depressive disorders were evaluated at baseline and 1year after ACS, using the Mini-International Neuropsychiatric Interview. Serum IL-1β levels and IL-1β genotypes were investigated at baseline. Covariates on socio-demographic and clinical characteristics including depressive symptoms, cardiovascular risk factors, and current cardiac status were assessed. Depression during the acute ACS was significantly associated with the IL-1β levels and the -511T allele. The interaction of the IL-1β level with depression at baseline in the presence of the -511T allele was also significant. No associations were found with depression during the chronic ACS. For the +3953C/T genotype, there was no association with depression in either the acute or chronic phase. The IL-1β level and -511C/T genotype, separately or interactively, could be a biomarker for depressive disorder in the acute phase of ACS. Focused interventions for those with higher IL-1β level and -511T allele might reduce the risk of depressive disorder.

Association of the Interaction Between Smoking and Depressive Symptom Clusters With Coronary Artery Calcification: The CARDIA Study

OBJECTIVE

Depressive symptom clusters are differentially associated with prognosis among patients with cardiovascular disease (CVD). Few studies have prospectively evaluated the association between depressive symptom clusters and risk of CVD. Previously, we observed that smoking and global depressive symptoms were synergistically associated with coronary artery calcification (CAC). The purpose of this study was to determine whether the smoking by depressive symptoms interaction, measured cumulatively over 25 years, differed by depressive symptom cluster (negative affect, anhedonia, and somatic symptoms) in association with CAC.

METHODS

Participants (N = 3,189: 54.5% female; 51.5% Black; average age = 50.1 years) were followed from 1985-1986 through 2010-2011 in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Smoking exposure was measured by cumulative cigarette pack-years (cigarette packs smoked per day × number of years smoking; year 0 through year 25). Depressive symptoms were measured using a 14-item, 3-factor (negative affect, anhedonia, somatic symptoms) model of the Center for Epidemiologic Studies Depression (CES-D) Scale (years 5, 10, 15, 20, and 25). CAC was assessed at year 25. Logistic regression models were used to evaluate the association between the smoking by depressive symptom clusters interactions with CAC ( = 0 vs. > 0), adjusted for CVD-related sociodemographic, behavioral, and clinical covariates.

RESULTS

907 participants (28% of the sample) had CAC > 0 at year 25. The depressive symptom clusters did not differ significantly between the two groups. Only the cumulative somatic symptom cluster by cumulative smoking exposure interaction was significantly associated with CAC > 0 at year 25 (p = .028). Specifically, adults with elevated somatic symptoms (score 9 out of 18) who had 10, 20, or 30 pack-years of smoking exposure had respective odds ratios (95% confidence intervals) of 2.06 [1.08, 3.93], 3.71 [1.81, 7.57], and 6.68 [2.87, 15.53], ps < .05. Negative affect and anhedonia did not significantly interact with smoking exposure associated with CAC >0, ps > .05.

CONCLUSIONS

Somatic symptoms appear to be a particularly relevant cluster of depressive symptomatology in the relationship between smoking and CVD risk.

Depression 12-months after coronary artery bypass graft is predicted by cortisol slope over the day

Alterations in the diurnal profile of cortisol have been associated with depressed mood in patients with coronary heart disease. The relationship between cortisol output and depressed mood has not been investigated prospectively in coronary artery bypass graft (CABG) patients before. We aimed to study the relationship between cortisol measured pre- and post-operatively and depression symptoms measured 12 months after CABG surgery. We analysed data from 171 patients awaiting first-time, elective CABG surgery from the pre-assessment clinic at St. George's Hospital, London. The Beck Depression Inventory (BDI) was used to assess depression symptoms and saliva samples were collected to measure diurnal cortisol. Baseline assessments of depression and cortisol were obtained an average 29days before surgery, short-term follow-up of cortisol occurred 60days after surgery and long-term follow-up of depression was assessed 378days after surgery. Baseline cortisol slope was not associated with depression at 12-month follow-up. However, a steeper cortisol slope measured 60days after surgery predicted reduced odds of depression (BDI≥10) 12 months after surgery (odds ratio 0.661, 95% confidence interval 0.437-0.998, p=0.049) after controlling for covariates. These findings suggest interventions aimed at improving adaptation in the early recovery period may have long-term benefits in this patient group.

Mind injuries after cardiac surgery

After cardiac surgery, delirium, cognitive dysfunction, depression, or anxiety disorders frequently occur, and profoundly affect patients' prognosis and quality of life. This narrative review focuses on the main clinical presentations of cognitive and psychological problems ('mind injuries') that occur postoperatively in absence of ascertainable focal neurologic deficits, exploring their pathophysiological mechanisms and possible strategies for prevention and treatment. Postoperative cognitive dysfunction is a potentially devastating complication that can involve several mechanisms and several predisposing, intraoperative, and postoperative risk factors, which can result in or be associated to cerebral microvascular damage. Postoperative depression is influenced by genetic or psychosocial predisposing factors, by neuroendocrine activation, and by the release of several pro-inflammatory factors. The net effect of these changes is neuroinflammation. These complex biochemical alterations, along with an aspecific response to stressful life events, might target the function of several brain areas, which are thought to represent a trigger factor for the onset of depression.

Depression and the Link with Cardiovascular Disease

This review provides an outline of the association between major depressive disorder (MDD) and coronary heart disease (CHD). Much is known about the two individual clinical conditions; however, it is not until recently, biological mechanisms have been uncovered that link both MDD and CHD. The activation of stress pathways have been implicated as a neurochemical mechanism that links MDD and CHD. Depression is known to be associated with poorer outcomes of CHD. Psychological factors, such as major depression and stress, are now known as risk factors for developing CHD, which is as important and is independent of classic risk factors, such as hypertension, diabetes mellitus, and cigarette smoking. Both conditions have great socioeconomic importance given that depression and CHD are likely to be two of the three leading causes of global burden of disease. Better understanding of the common causal pathways will help us delineate more appropriate treatments.

Do depressive symptoms predict cancer incidence?: 17-year follow-up of the Whitehall II study

OBJECTIVE

To explore the association between depressive symptom history and cancer incidence.

METHODS

Affective/emotional depressive symptoms were assessed using the General Health Questionnaire (GHQ-30) depression sub-scale across phase 1 (1985-1988), phase 2 (1989-1990), and phase 3 (1991-1994) of the Whitehall II prospective cohort study; 'chronic'=depressive episode at phase 1, 2 and 3; 'new'=depressive episode at phase 3 only. Cancer incidence was obtained from the National Health Service Central Register with an average follow-up of 15.6 years (range 0.08-17.4). The study sample consisted of 6983 participants, aged 35-55 years at baseline. Results were adjusted for age, sex, socio-economic position, health behaviours, health status/conditions, medication, and social support.

RESULTS

Over a 17.4 year follow-up, chronic depressive symptoms did not increase the risk of cancer incidence compared to those who never experienced symptoms (hazard ratio (HR)=1.03, 95% confidence interval (CI): 0.71-1.49). Participants who experienced new depressive symptoms had an increased risk of cancer incidence in the first 9 years of follow-up (HR=1.89, 95% CI: 1.23-2.90) but no increased risk in later years (HR=0.84, 95% CI: 0.52-1.35).

CONCLUSION

Chronic depressive symptoms were not associated with cancer incidence. In contrast, new-onset symptoms were associated with a substantially increased risk, possibly due to reverse causality.

Depression--a common disorder across a broad spectrum of neurological conditions: a cross-sectional nationally representative survey

OBJECTIVE

To estimate the prevalence of depression across a range of neurological conditions in a nationally representative sample.

METHODS

The data source was the Survey of Living with Neurological Conditions in Canada (SLNCC), which accrued its sample by selecting participants from the Canadian Community Health Survey. The point prevalence of depression was estimated by assessment of depressive symptoms with the Patient Health Questionnaire, Brief (Patient Health Questionnaire, 9-item).

RESULTS

A total of n=4408 participated in the SLNCC. The highest point prevalence of depression (>30%) was seen in those with traumatic brain injury and brain/spinal cord tumors. Depression was also highly prevalent (18-28%) in those with (listed from highest to lowest) Alzheimer's disease/dementia, dystonia, multiple sclerosis, Parkinson's disease, stroke, migraine, epilepsy and spina bifida. The odds ratios for depression, with the referent group being the general population, were significant (from highest to lowest) for migraine, traumatic brain injury, stroke, dystonia and epilepsy.

CONCLUSIONS

All neurological conditions included in this study are associated with an elevated prevalence of depression in community populations. The conditions with the highest prevalence are traumatic brain injury and brain/spinal cord tumors.

Acute coronary syndrome-associated depression: the salience of a sickness response analogy?

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.

NGAL and other markers of inflammation as competitive or complementary markers for depressive symptom dimensions in heart failure

OBJECTIVES

Neutrophil gelatinase-associated lipocalin (NGAL) is an inflammatory marker associated with the pathophysiology of heart failure (HF), the psychopathology of depression and the co-existing symptoms of depression in HF patients. The aim of this study is to determine whether the association of serum NGAL levels with depressive symptoms dimensions in HF is independent of well-known inflammatory markers.

METHODS

Serum NGAL, high sensitive C-reactive protein (hsCRP), tumour necrosis factor-α (TNF-α), its two soluble receptors; sTNFR1, sTNFR2, Interleukin-6 (IL-6) and leukocytes were measured in 104 patients with HF at baseline and 12 months. Depressive symptoms were evaluated using the Beck Depression Inventory (BDI) at both timepoints. Correlations between NGAL and inflammatory markers and depressive symptoms dimensions were determined. The effect of hsCRP, IL-6, TNF-α, sTNFR1, sTNFR2 and leukocytes on the association of NGAL with depressive symptoms was determined and adjusted for time, demographics, cardiac disease severity, and kidney function.

RESULTS

NGAL levels were significantly correlated with hsCRP, TNF-α, sTNFR1, sTNFR2 and leukocytes. NGAL was significantly associated with somatic depressive symptoms, independent of abovementioned markers.

CONCLUSIONS

Serum NGAL is an independent inflammatory marker for somatic depressive symptoms in HF and may function as an immunopathogen linking somatic symptoms of depression to HF.

Dietary inflammatory index, cardiometabolic conditions and depression in the Seguimiento Universidad de Navarra cohort study

Only one prospective study has analysed the relationship between the inflammatory properties of diet and risk of depression thus far. The aim of this study was to assess the association between the dietary inflammatory index (DII) and the incidence of depression. In a cohort study of 15 093 university graduates, participants completed a validated FFQ at baseline and after 10 years of follow-up. The DII was calculated based on the FFQ. Each of the twenty-eight nutrients or foods received a score based on findings from the peer-reviewed literature reporting on the relationships between diet and inflammatory biomarkers (IL-1β, IL-4, IL-6, IL-10, TNF-α and C-reactive protein). Participants were classified as having depression if they reported a new clinical diagnosis of depression by a physician, antidepressant drugs, or both. Multivariable Cox regression models were used to estimate hazard ratios (HR) of depression according to quintiles of the DII. After a median 8·5 years of follow-up, we observed 1051 incident cases of depression. The HR for participants in the highest quintile of DII (strongly pro-inflammatory) was 1·47 (95% CI 1·17, 1·85) compared with those in the bottom quintile, with a significant dose-response relationship (P trend=0·01). In the subgroup analyses, the association between DII and depression was stronger among participants >55 years and among those with cardiometabolic comorbidities (HR 2·70; 95% CI 1·22, 5·97 and HR 1·80; 95% CI 1·27, 2·57, respectively). A pro-inflammatory diet was associated with a significantly higher risk of depression in a Mediterranean population. This association was stronger among older subjects and subjects with cardiometabolic diseases.

Characterising acute coronary syndrome-associated depression: Let the data speak

Depression in the context of acute coronary syndrome (ACS) is understood to confer increased morbidity and mortality risk. The pathophysiological mechanisms underlying this association remain poorly understood, although several candidates including inflammation, cardiac autonomic dysregulation, and behavioural factors are viewed as of key importance. No single bio-behavioural explanatory model of ACS-associated depression has emerged, likely due the substantial heterogeneity across both conditions. We studied 344 patients with ACS; 45 fulfilled diagnostic (DSM-IV) criteria for a major depressive episode occurring within 1-month of ACS, and 13 had ongoing major depression that pre-dated ACS and continued through to 1 month post-ACS. We employed two statistical methods (multinomial logistic regression; and latent class analysis) and a range of immunological, autonomic and nutritional markers in an attempt to characterise a biological basis for ACS-associated depression. Regression modelling failed to accurately predict categorical group membership of ACS-associated depression. An alternative data-driven approach produced a three-class solution, with the derived classes differing on measure of C-reactive protein, vitamin D, omega-6:omega-3 ratio, heart rate variability, and age (all p⩽0.004). The majority of participants with ACS-associated and ongoing depression were members of the class characterised by the greatest biological disturbance. Patients with depression differed from those without depression on a range of psychological trait and state variables; additionally reporting poorer sleep quality, higher levels of social isolation, and functional impairment, but had similar biological profiles. Patients with ongoing depression generally had higher scores on these psychological/behavioural measures. Our novel analytic approach identified a combination of biomarkers suggestive of a role for immune, autonomic, and nutritional pathways in the manifestation of depression during ACS, in the context of additional psychosocial and behavioural vulnerabilities. Further studies are required to confirm the causal role of these factors in perpetuating depression and increasing risk of poor-health outcomes.

A review of the neuro- and systemic inflammatory responses in post concussion symptoms: Introduction of the "post-inflammatory brain syndrome" PIBS

Post-concussion syndrome is an aggregate of symptoms that commonly present together after head injury. These symptoms, depending on definition, include headaches, dizziness, neuropsychiatric symptoms, and cognitive impairment. However, these symptoms are common, occurring frequently in non-head injured controls, leading some to question the existence of post-concussion syndrome as a unique syndrome. Therefore, some have attempted to explain post-concussion symptoms as post-traumatic stress disorder, as they share many similar symptoms and post-traumatic stress disorder does not require head injury. This explanation falls short as patients with post-concussion syndrome do not necessarily experience many key symptoms of post-traumatic stress disorder. Therefore, other explanations must be sought to explain the prevalence of post-concussion like symptoms in non-head injury patients. Many of the situations in which post-concussion syndrome like symptoms may be experienced such as infection and post-surgery are associated with systemic inflammatory responses, and even neuroinflammation. Post-concussion syndrome itself has a significant neuroinflammatory component. In this review we examine the evidence of neuroinflammation in post-concussion syndrome and the potential role systemic inflammation plays in post-concussion syndrome like symptoms. We conclude that given the overlap between these conditions and the role of inflammation in their etiologies, a new term, post-inflammatory brain syndromes (PIBS), is necessary to describe the common outcomes of many different inflammatory insults. The concept of post-concussion syndrome is in its evolution therefore, the new term post-inflammatory brain syndromes provides a better understanding of etiology of its wide-array of symptoms and the wide array of conditions they can be seen in.

The role of neutrophil gelatinase associated lipocalin (NGAL) as biological constituent linking depression and cardiovascular disease

Depression is more common in patients with cardiovascular disease than in the general population. Conversely, depression is a risk factor for developing cardiovascular disease. Comorbidity of these two pathologies worsens prognosis. Several mechanisms have been indicated in the link between cardiovascular disease and depression, including inflammation. Systemic inflammation can have long-lasting effects on the central nervous system, which could be associated with depression. NGAL is an inflammatory marker and elevated plasma levels are associated with both cardiovascular disease and depression. While patients with depression show elevated NGAL levels, in patients with comorbid heart failure, NGAL levels are significantly higher and associated with depression scores. Systemic inflammation evokes NGAL expression in the brain. This is considered a proinflammatory effect as it is involved in microglia activation and reactive astrocytosis. Animal studies support a direct link between NGAL and depression/anxiety associated behavior. In this review we focus on the role of NGAL in linking depression and cardiovascular disease.

High sensitivity C reactive protein, fibrinogen levels and the onset of major depressive disorder in post-acute coronary syndrome

Background

Major depression disorder (MDD) is a common condition in patients suffering from acute coronary syndrome (ACS), and depression is a risk factor for mortality following an ACS. Growing evidence suggests that there is an intricate interplay between atherosclerosis, inflammation and depression. The aim of this study was to investigate the role of atherosclerosis-induced inflammation in the mediation of MDD.

Methods

87 patients without depression were recruited at the time of an ACS, evaluated at 3 and 7 days and followed at 1, 3 and 9 months for the occurrence of a MDD as assessed by structured interviews (MINI). At each time point, they were monitored for inflammatory markers (high sensitivity C Reactive Protein {hsCRP} and fibrinogen), cardiovascular risk factors and atherosclerosis burden. Association between possible predictive characteristics and depression was assessed using a multivariable logistic regression model.

Results

The overall incidence of MDD, in this population, was 28.7% [95% CI: 19.5 – 39.4] during the 9-month follow up period. Elevated hsCRP was not associated with depression onset after an ACS (adjusted OR: 1.07 [0.77 - 1.48]; p = 0.70), and similarly no association was found with fibrinogen. Furthermore, we found no association between hsCRP, fibrinogen or atherosclerosis burden at any time-point, and the occurrence of a MDD (or HDRS-17 and MADRS). The only factor associated with depression occurrence after an ACS was a previous personal history of depression (adjusted OR: 11.02 [2.74 to 44.34]; p = 0.0007).

Conclusions

The present study shows that after an ACS, patients treated with optimal medications could have a MDD independent of elevated hsCRP or fibrinogen levels. Personal history of depression may be a good marker to select patients who should be screened for depression after an ACS.

Electronic supplementary material

The online version of this article (doi:10.1186/s12872-015-0015-3) contains supplementary material, which is available to authorized users.

Depression and anxiety following myocardial infarction and their inverse associations with future health behaviors and quality of life

BACKGROUND

Post-myocardial infarction (MI) depression and anxiety were found to predict prognosis and quality of life.

PURPOSE

The purpose of this study was to test a behavioral pathway from post-MI depression/anxiety to future quality of life.

METHODS

This is a longitudinal cohort study. Five hundred forty patients (≤65 years old) filled out questionnaires after a first MI, including socio-demographics, pre-MI health status and behaviors, MI severity, social support, sense of coherence, depression, and anxiety. Reports of health behaviors were obtained 5 years and of quality of life 10 years later.

RESULTS

A structural equations model confirmed that depression and anxiety were directly related to poorer quality of life 10 years later. These relationships were partly mediated by a positive association between anxiety and health behaviors at 5 years and a negative one between depression and health behaviors.

CONCLUSIONS

The opposite effects of anxiety and depression underscore the need to attend to both emotional reactions to MI while encouraging preventive health behaviors.

Peripheral cytokines as a chemical mediator for postconcussion like sickness behaviour in trauma and perioperative patients: literature review

Besides brain injury and systemic infection, cognitive and concussion like sickness behaviour is associated with muscular trauma and perioperative patients, which represents a major obstacle to daily activities and rehabilitation. The neuroinflammatory response triggers glial activation and consequently the release of proinflammatory cytokines within the hippocampus. We review clinical studies that have investigated neurocognitive and psychosomatic symptoms related to muscular trauma and in perioperative conditions. These include impaired attention and executive and general cognitive functioning. The purpose of this literature review is to focus on the systemic inflammation and the role of proinflammatory cytokines IL1, IL6,and TNF and other inflammatory mediators which mediates the cognitive impairment and induces sickness behaviour. Moreover, this review will also help to determine if some patients could have long-term cognitive changes associated with musculoskeletal injuries or as a consequence of surgery and thereby will lead to efforts in reducing that risk.

History of depression but not current depression is associated with signs of atherosclerosis: data from the Gutenberg Health Study

OBJECTIVES

To test the vascular depression hypothesis in the general population, we analyzed the association between current depression, medical history of depression, cognitive and somatic depressive symptom dimensions and measures of atherosclerosis [intima-media thickness (IMT) and carotid plaques].

METHOD

We included a representative sample of 5000 participants from the Gutenberg Health Study (GHS). Depression was assessed by the nine-item Patient Health Questionnaire (PHQ-9), and IMT and carotid plaques were measured at both common carotid arteries using an edge detection system. Regression analyses were performed separately for participants with and without cardiovascular disease, adjusting for medical history, cardiovascular risk factors and psychotropic medication.

RESULTS

Contrary to hypotheses, we found no increased IMT for somatic symptoms of depression; the same was true for depression and cognitive symptoms in the fully adjusted model. Only a moderate relationship between medical history of depression and the presence of atherosclerotic plaques was maintained after correction.

CONCLUSIONS

The relationship between depression and atherosclerosis may be more complex than previously assumed. Although the vascular depression hypothesis was not supported, our results support the hypothesis that lasting depression leads to arteriosclerosis.

Depression as a risk factor for poor prognosis among patients with acute coronary syndrome: systematic review and recommendations: a scientific statement from the American Heart Association

BACKGROUND

Although prospective studies, systematic reviews, and meta-analyses have documented an association between depression and increased morbidity and mortality in a variety of cardiac populations, depression has not yet achieved formal recognition as a risk factor for poor prognosis in patients with acute coronary syndrome by the American Heart Association and other health organizations. The purpose of this scientific statement is to review available evidence and recommend whether depression should be elevated to the status of a risk factor for patients with acute coronary syndrome.

METHODS AND RESULTS

Writing group members were approved by the American Heart Association's Scientific Statement and Manuscript Oversight Committees. A systematic literature review on depression and adverse medical outcomes after acute coronary syndrome was conducted that included all-cause mortality, cardiac mortality, and composite outcomes for mortality and nonfatal events. The review assessed the strength, consistency, independence, and generalizability of the published studies. A total of 53 individual studies (32 reported on associations with all-cause mortality, 12 on cardiac mortality, and 22 on composite outcomes) and 4 meta-analyses met inclusion criteria. There was heterogeneity across studies in terms of the demographic composition of study samples, definition and measurement of depression, length of follow-up, and covariates included in the multivariable models. Despite limitations in some individual studies, our review identified generally consistent associations between depression and adverse outcomes.

CONCLUSIONS

Despite the heterogeneity of published studies included in this review, the preponderance of evidence supports the recommendation that the American Heart Association should elevate depression to the status of a risk factor for adverse medical outcomes in patients with acute coronary syndrome.

Alcohol intake, wine consumption and the development of depression: the PREDIMED study

BACKGROUND

Alcoholic beverages are widely consumed. Depression, the most prevalent mental disorder worldwide, has been related to alcohol intake. We aimed to prospectively assess the association between alcohol intake and incident depression using repeated measurements of alcohol intake.

METHODS

We followed-up 5,505 high-risk men and women (55 to 80 y) of the PREDIMED Trial for up to seven years. Participants were initially free of depression or a history of depression, and did not have any history of alcohol-related problems. A 137-item validated food frequency questionnaire administered by a dietician was repeated annually to assess alcohol intake. Participants were classified as incident cases of depression when they reported a new clinical diagnosis of depression, and/or initiated the use of antidepressant drugs. Cox regression analyses were fitted over 23,655 person-years.

RESULTS

Moderate alcohol intake within the range of 5 to 15 g/day was significantly associated with lower risk of incident depression (hazard ratio (HR) and 95% confidence interval (95% CI) = 0.72 (0.53 to 0.98) versus abstainers). Specifically, wine consumption in the range of two to seven drinks/week was significantly associated with lower rates of depression (HR (95% CI) = 0.68 (0.47 to 0.98)).

CONCLUSIONS

Moderate consumption of wine may reduce the incidence of depression, while heavy drinkers seem to be at higher risk.

Differential associations of depressive symptom dimensions with cardio-vascular disease in the community: results from the Gutenberg health study

A current model suggested that the somatic symptom dimension accounts for the adverse effect of depression in patients with coronary heart disease (CHD). In order to test this model we sought to determine in a large population-based sample how symptom dimensions of depression are associated with CHD, biomarkers and traditional risk factors. The associations of cognitive and somatic symptom dimensions of depression with CHD, risk factors, endothelial function, and biomarkers of inflammation and myocardial stress were analyzed cross-sectionally in a sample of n = 5000 Mid-Europeans aged 35–74 years from the Gutenberg Health Study (GHS). Only the somatic symptom dimension of depression was associated with CHD, biomarkers (inflammation, vascular function) and cardio-vascular risk factors. When multivariable adjustment was applied by demographic and cardiovascular risk factors, the weak associations of the somatic symptom dimension with the biomarkers disappeared. However, the associations of the somatic symptom dimension with CHD, myocardial infarction, obesity, dyslipidemia and family history of myocardial infarction remained. Both dimensions of depression were independently associated with a previous diagnosis of depression and distressed personality (type D). Thus, our results partly confirm current models: Somatic, but not cognitive-affective symptom dimensions are responsible for the association between depression and CHD, inflammation, vascular function and cardiovascular risk factors in the general population. However, our findings challenge the assumptions that somatic depression might be due to inflammation or vascular dysfunction as consequence of progressed atherosclerotic disease. They rather emphasize a close interplay with life-style factors and with a family history of MI.

Inflammation and symptoms of depression and anxiety in patients with acute coronary heart disease

Depression following an acute coronary syndrome (ACS, including myocardial infarction or unstable angina) is associated with recurrent cardiovascular events, but the depressive symptoms that are cardiotoxic appear to have particular characteristics: they are 'incident' rather than being a continuation of prior depression, and they are somatic rather than cognitive in nature. We tested the hypothesis that the magnitude of inflammatory responses during the ACS would predict somatic symptoms of depression 3 weeks and 6 months later, specifically in patients without a history of depressive illness. White cell count and C-reactive protein were measured on the day after admission in 216 ACS patients. ACS was associated with very high levels of inflammation, averaging 13.23×10(9)/l and 17.06 mg/l for white cell count and C-reactive protein respectively. White cell count during ACS predicted somatic symptom intensity on the Beck Depression Inventory 3 weeks later (β=0.122, 95% C.I. 0.015-0.230, p=0.025) independently of age, sex, ethnicity, socioeconomic status, marital status, smoking, cardiac arrest during admission and clinical cardiac risk, but only in patients without a history of depression. At 6 months, white cell count during ACS was associated with elevated anxiety on the Hospital Anxiety and Depression Scale independently of covariates including anxiety measured at 3 weeks (adjusted odds ratio 1.08, 95% C.I. 1.01-1.15, p=0.022). An unpredicted relationship between white cell count during ACS and cognitive symptoms of depression at 6 months was also observed. The study provides some support for the hypothesis that the marked inflammation during ACS contributes to later depression in a subset of patients, but the evidence is not conclusive.

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

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.