Socioeconomic Position and Antidepressant Use as Predictors of Coronary Heart Disease Mortality: A Population-Based Registry Study of 362,271 Finns

Depressive symptoms, lifestyle behaviors, and risk of cardiovascular disease and mortality in individuals of different socioeconomic status: A prospective cohort study

BACKGROUND

Depression is a global health issue, associated with increased risk of cardiovascular disease (CVD) and premature death, but whether the association varied across different socioeconomic status (SES), and mechanisms responsible for this association is unclear. We aimed to evaluate the association of depressive symptoms with the risk of incident CVD and mortality in people of low, medium, and high SES, and determine the extent to which lifestyle behaviors could explain the association.

METHODS

This study included 314,800 participants from the UK Biobank. Depressive symptoms were assessed using the Patient Health Questionnaire-2 (PHQ-2). Information on socioeconomic status and lifestyle was obtained from baseline assessment.

RESULTS

During 12 years of follow-up, 29,074 incident CVD cases and 16,673 deaths were documented. The increased CVD risk in participants with depressive symptoms (versus without) was more pronounced as SES decreased, with hazard ratios (HRs) and 95% confidence intervals (CIs) of 1.30 (1.22, 1.39), 1.27 (1.17, 1.37), and 1.17 (0.97, 1.41) in participants of low, medium, and high SES, respectively. The corresponding HRs (95% CIs) for all-cause mortality were 1.16 (1.07, 1.26), 1.21 (1.08, 1.36), and 1.24 (0.95, 1.61). In addition, multiple lifestyle factors together explained 14.4% to 32.8% of the elevated CVD and mortality risk due to depressive symptoms.

LIMITATIONS

Moderate sensitivity of PHQ-2, lacked information on the severity of depression, baseline measurement of lifestyle.

CONCLUSIONS

Depressive symptoms were associated with higher risks of incident CVD and mortality, especially in low SES groups, and lifestyle behaviors only explained a moderate proportion of the association. These findings indicated that health policies targeting healthy lifestyle promotion alone might not be sufficient, and other measures tackling social inequity are warranted to attenuate the elevated health risk due to depression.

Symptom specificity of ayahuasca's effect on depressive symptoms

Background

Ayahuasca's effects on symptoms of depression have generated considerable optimism. Clients frequently report more concern about some symptoms than others, and available treatments alter symptoms differentially. Few studies address the symptom specificity of this psychoactive brew.

Aims

We examined self-reported effects of ayahuasca on the individual symptoms of depression assessed by the 10-item short-form of Center for Epidemiological Studies of Depression (CESD-10).

Methods

We asked over 120 participants to complete a retrospective assessment of CESD-10 symptoms one month before and one month after using ayahuasca.

Results

Participants indicated that ayahuasca had a larger influence on affective symptoms like hope, depressed mood, and happiness, than cognitive, interpersonal, and somatic symptoms like restless sleep, loneliness, and difficulty focusing.

Conclusions

Potential clients might appreciate identifying if different treatments provide more relief for some depressive symptoms than others. We examined retrospective reports of ayahuasca's potential for differential impact. Those eager to alter hope, happiness, and other affective symptoms will likely find ayahuasca more helpful than those who want an intervention for restless sleep, loneliness, or trouble focusing. This symptom specificity parallels the effects of serotonergic antidepressant medications, suggesting that psychedelic-assisted psychotherapy using ayahuasca might have considerable appeal for those who seek comparable relief but would rather not use prescription serotonergic medications. Jumpstarting psychotherapy with the rapid onset of ayahuasca-induced relief also appears to have potential.

Cognitive Behavioral Therapy, Ketamine, and Combination Treatment for Depression: Impressions of Credibility in Participants with Self-Reported Depressive Symptoms

Ketamine, a novel treatment for depression, has generated considerable interest and research. Few experiments address lay impressions of the credibility of ketamine treatment relative to another popular intervention for depression, CBT. Over 500 participants with depressive symptoms read descriptions of CBT, ketamine, and a treatment that combined the two. Descriptions included pros and cons of each approach. Participants found the combination treatment more credible than ketamine but no better than CBT alone. They rated the credibility of CBT alone significantly higher than ketamine alone. Participants with psychotherapy experience tended to view ketamine as less credible than those who did not report previous psychotherapy. Depression scores did not covary with credibility ratings for any treatment. Despite media coverage and Internet claims, potential clients are cautious about ketamine. These results suggest that providing descriptions of treatments might help reveal important information about their credibility to potential clients. Extended work assessing impressions of many approaches to the treatment of psychopathology and other problems appears justifiable. Given established links between credibility and treatment outcome, additional research on individual differences in perceptions of ketamine and varied treatments for depression seems warranted.

Psychedelic-assisted psychotherapy for depression: How dire is the need? How could we do it?

Despite the popular support for psychedelics as aids for depression, academics and the public frequently overestimate the efficacy of available medications and psychotherapies. Metaanalyses reveal that antidepressant medications alone help only one in four patients and rarely surpass credible placebos. Their effects, though statistically significant, might not impress depressed patients themselves. Psychotherapies create better outcomes than antidepressant drugs alone; combining the two provides measurable advantages. Nevertheless, the best combinations help only 65% of the clients who complete treatment. The drugs create side-effects and withdrawal surprisingly more severe than professional guidelines imply, too. Psychedelics appear to improve depression through some of the same mechanisms as psychotherapy, as well as some novel ones, suggesting that the combination could work very well. In addition, subjective experiences during the psychedelic sessions covary with improvement. Guiding clients to focus on these targeted thoughts and feelings could improve outcome. These data underscore the serious need for clinical trials of psychedelic-assisted, empirically supported treatment for depression with guided experiences during the psychedelic session. These trials would require important components to maximize their impact, including meaningful preparatory sessions designed to enhance motivation and explain empirically supported approaches, guided administration sessions that focus on oceanic boundlessness, integration sessions that support progress, and follow-up sessions consistent with established research. This combination involves markedly more than a simple pairing of medication and talk therapy, but proper application could have an unparalleled impact on public health.

Could Cardiovascular Health Metrics Account for Age and Sex Disparities in Self-Reported Ischemic Heart Disease Prevalence?

The American Heart Association has outlined seven modifiable cardiovascular health (CVH) metrics. However, the sex and age disparities in the association between those CVH metrics and ischemic heart disease (IHD) prevalence are unclear. Our study sought to examine the possible sex and age variations in the association between CVH metrics and IHD prevalence using an Australian nationally representative survey. We used the core sample of the 2011⁻2012 Australian Health Survey, and 7499 adults with fasting plasma glucose (FPG) and total cholesterol values were included. We used Poisson regression analysis to measure the associations between individual metrics and IHD prevalence. Our study used both stratification and interaction analyses to compare the magnitude of associations between sex and age groups. Then, we calculated the population attributable fractions to measure the contribution of each metric to IHD prevalence. In addition, we applied logistic regression analysis to examine the influences of ideal CVH metrics number on IHD prevalence and used stratification and interaction analyses. Body mass index, physical activity, blood pressure, and FPG have greater effects on IHD prevalence in young adults compared to older adults. We failed to detect the sex variations in CVH metrics and IHD prevalence. The ideal CVH metrics number was inversely correlated to IHD prevalence and it has similar effects in four subgroups. These CVH metrics do not explain the sex and age disparities in IHD prevalence and the topic need further explorations.