Comorbidity of cardiovascular diseases with mood and anxiety disorder: a population based 4-year study

A Potential Role for MAGI-1 in the Bi-Directional Relationship Between Major Depressive Disorder and Cardiovascular Disease

PURPOSE OF REVIEW

Major Depressive Disorder (MDD) is characterized by persistent symptoms such as fatigue, loss of interest in activities, feelings of sadness and worthlessness. MDD often coexist with cardiovascular disease (CVD), yet the precise link between these conditions remains unclear. This review explores factors underlying the development of MDD and CVD, including genetic, epigenetic, platelet activation, inflammation, hypothalamic-pituitary-adrenal (HPA) axis activation, endothelial cell (EC) dysfunction, and blood-brain barrier (BBB) disruption.

RECENT FINDINGS

Single nucleotide polymorphisms (SNPs) in the membrane-associated guanylate kinase WW and PDZ domain-containing protein 1 (MAGI-1) are associated with neuroticism and psychiatric disorders including MDD. SNPs in MAGI-1 are also linked to chronic inflammatory disorders such as spontaneous glomerulosclerosis, celiac disease, ulcerative colitis, and Crohn's disease. Increased MAGI-1 expression has been observed in colonic epithelial samples from Crohn's disease and ulcerative colitis patients. MAGI-1 also plays a role in regulating EC activation and atherogenesis in mice and is essential for Influenza A virus (IAV) infection, endoplasmic reticulum stress-induced EC apoptosis, and thrombin-induced EC permeability. Despite being understudied in human disease; evidence suggests that MAGI-1 may play a role in linking CVD and MDD. Therefore, further investigation of MAG-1 could be warranted to elucidate its potential involvement in these conditions.

Rethinking the role of trazodone in the different depressive dimensions

INTRODUCTION

The efficacy of trazodone for several psychopathologic dimensions of depression has been shown in the literature. Trazodone has been widely used in some clinical contexts (e.g. for insomnia and depression in the elderly). However, the role of trazodone in several aspects of depression is not well known.

AREA COVERED

Eight experts from academic and medical centers across Italy met to identify the difficulties and barriers faced in daily clinical practice in the assessment and management of major depressive disorder and how the use of trazodone could address some unmet needs. The objective of the expert meetings and the present document was to increase knowledge of particular areas of treatment with trazodone.

EXPERT OPINION

Evidence of the role of trazodone in patients affected by major depressive disorder with anxiety symptoms, insomnia, agitation, cognitive deficits, alcohol use disorders, physical comorbidities, and suicide risk has been identified, showing the effectiveness of trazodone in different presentations of major depressive disorder. The main characteristics of patients with depression for whom trazodone seems to be most effective have been identified, providing clinicians with information on possible uses of this drug in such population of patients.

A Mendelian randomization study of the effect of mental disorders on cardiovascular disease

Objective

The effect of mental disorders (MD) on cardiovascular disease (CVD) remains controversial, and this study aims to analyze the causal relationship between eight MD and CVD by Mendelian randomization (MR).

Methods

Single nucleotide polymorphisms of attention-deficit/hyperactivity disorder (ADHD), anorexia nervosa (AN), anxiety disorder (ANX), autism spectrum disorder (ASD), bipolar disorder (BD), depression, obsessive-compulsive disorder (OCD), schizophrenia (SCZ), and CVD were obtained from UK Biobank and FinnGen. Exposure-outcome causality was tested using inverse variance weighted (IVW), MR-Egger, and weighted median. Horizontal pleiotropy and heterogeneity were assessed by MR-Egger intercept and Cochran's Q, respectively, while stability of results was assessed by leave-one-out sensitivity analysis.

Results

MR analysis showed that ANX (IVW [odds ratio (OR) 1.11, 95% confidence intervals (CI) 1.07-1.15, p < 0.001]; MR-Egger [OR 1.03, 95% CI 0.92-1.14, p = 0.652]; weighted median [OR 1.09, 95% CI 1.03-1.14, p = 0.001]), ASD (IVW [OR 1.05, 95% CI 1.00-1.09, p = 0.039]; MR-Egger [OR 0.95, 95% CI 0.84-1.07, p = 0.411]; weighted median [OR 1.01, 95% CI 0.96-1.06, p = 0.805]), depression (IVW [OR 1.15, 95% CI 1.10-1.19, p < 0.001]; MR-Egger [OR 1.10, 95% CI 0.96-1.26, p = 0.169]; weighted median [OR 1.13, 95% CI 1.08-1.19, p < 0.001]) were significantly associated with increased risk of CVD, whereas ADHD, AN, BD, OCD, and SCZ were not significantly associated with CVD (p > 0.05). Intercept analysis showed no horizontal pleiotropy (p > 0.05). Cochran's Q showed no heterogeneity except for BD (p = 0.035). Sensitivity analysis suggested that these results were robust.

Conclusions

ANX, ASD, and depression are associated with an increased risk of CVD, whereas AN, ADHD, BD, OCD, and SCZ are not causally associated with CVD. Active prevention and treatment of ANX, ASD, and depression may help reduce the risk of CVD.

Evaluation of subclinical cardiovascular risk in drug-naive pediatric patients with anxiety disorders

OBJECTIVE

This study examined subclinical atherosclerosis in drug-naïve children with anxiety disorders using non-invasive measures to investigate the clinical features associated with subclinical atherosclerosis.

METHOD

A total of 37 drug-naive children and adolescents with anxiety disorders and 37 healthy controls were included in the study. The Children's Depression Inventory (CDI) and the State-Trait Anxiety Inventory (STAI-T and STAI-S) were used to assess children's depression and anxiety levels. Carotid artery intima-media (cIMT), epicardial adipose tissue (EAT), and periaortic adipose tissue (PAT) thicknesses, which are indicators of subclinical atherosclerosis, were obtained by echocardiographic measurements.

RESULTS

Multivariate analysis of covariance (MANCOVA) revealed a significant main effect on cIMT, EAT thickness, and PAT thickness, independent of confounding factors such as age, sex, body mass index, mean blood pressure, and family income (Pillai's Trace V = .76, F (1, 72) = 35.60, P < .001, ηp2 = .76). Analysis of covariance (ANCOVA) showed that cIMT, EAT thickness, and PAT thickness values were significantly higher in the anxiety disorder group compared to the the control group (P < .001). In partial correlation analysis, a positive correlation was observed between STAI-T and cIMT and EAT thickness. In linear regression analyses, age and STAI-T were significantly correlated with cIMT and EAT thickness levels.

CONCLUSIONS

These results suggest that subclinical cardiovascular risk is significantly increased in children and adolescents with anxiety disorders.

Stakeholder-led understanding of the implementation of digital technologies within heart disease diagnosis: a qualitative study protocol

INTRODUCTION

Cardiovascular diseases are highly prevalent among the UK population, and the quality of care is being reduced due to accessibility and resource issues. Increased implementation of digital technologies into the cardiovascular care pathway has enormous potential to lighten the load on the National Health Service (NHS), however, it is not possible to adopt this shift without embedding the perspectives of service users and clinicians.

METHODS AND ANALYSIS

A series of qualitative studies will be carried out with the aim of developing a stakeholder-led perspective on the implementation of digital technologies to improve holistic diagnosis of heart disease. This will be a decentralised study with all data collection being carried out online with a nationwide cohort. Four focus groups, each with 5-6 participants, will be carried out with people with lived experience of heart disease, and 10 one-to-one interviews will be carried out with clinicians with experience of diagnosing heart diseases. The data will be analysed using an inductive thematic analysis approach.

ETHICS AND DISSEMINATION

This study received ethical approval from the Sciences and Technology Cross Research Council at the University of Sussex (reference ER/FM409/1). Participants will be required to provide informed consent via a Qualtrics survey before being accepted into the online interview or focus group. The findings will be disseminated through conference presentations, peer-reviewed publications and to the study participants.

Exploring the genetic correlation of cardiovascular diseases and mood disorders in the UK Biobank

AIMS

Cardiovascular diseases (CVDs) are the leading cause of deaths globally. Mortality and incidence of CVDs are significantly higher in people with mood disorders. About 81.1% of CVD patients were reported with comorbidities in 2019, where the second most common comorbidity was due to major depressive disorder (MDD). This study, therefore, aimed to evaluate the genetic correlation between CVDs and mood disorders by using data from the UK Biobank towards understanding the influence of genetic factors on the comorbidity due to CVDs and mood disorders.

METHODS

The UK Biobank database provides genetic and health information from half a million adults, aged 40-69 years, recruited between 2006 and 2010. A total of 117,925 participants and 6,128,294 variants were included for analysis after applying exclusion criteria and quality control steps. This study focused on two CVD phenotypes, two mood disorders and 12 cardiometabolic-related traits to conduct association studies.

RESULTS

The results indicated a significant positive genetic correlation between CVDs and overall mood disorders and MDD specifically, showing substantial genetic overlap. Genetic correlation between CVDs and bipolar disorder was not significant. Furthermore, significant genetic correlation between mood disorders and cardiometabolic traits was also reported.

CONCLUSIONS

The results of this study can be used to understand that CVDs and mood disorders share a great deal of genetic liability in individuals of European ancestry.

Coronary Artery Disease in Patients with Severe Mental Illness

Severe mental illnesses (SMI), such as schizophrenia and bipolar disorder, are associated with a decrease in life expectancy of up to two decades compared with the general population, with cardiovascular disease as the leading cause of death. SMI is associated with increased cardiovascular risk profile and early onset of incident cardiovascular disease. Following an acute coronary syndrome, patients with SMI have a worse prognosis, but are less likely to receive invasive treatment. In this narrative review, the management of coronary artery disease in patients with SMI is discussed, and avenues for future research are highlighted.

Developing a Smart Home Technology Innovation for People With Physical and Mental Health Problems: Considerations and Recommendations

Smart home technologies present an unprecedented opportunity to improve health and health care by providing greater communication and connectivity with services and care providers and by supporting the daily activities of people managing both mental and physical health problems. Based on our experience from conducting smart technology health studies, including a smart home intervention, we provide guidance on developing and implementing such interventions. First, we describe the need for an overarching principle of security and privacy that must be attended to in all aspects of such a project. We then describe 4 key steps in developing a successful smart home innovation for people with mental and physical health conditions. These include (1) setting up the digital infrastructure, (2) ensuring the components of the system communicate, (3) ensuring that the system is designed for the intended population, and (4) engaging stakeholders. Recommendations on how to approach each of these steps are provided along with suggested literature that addresses additional considerations, guidelines, and equipment selection in more depth.

Sex differences in the blood-brain barrier: Implications for mental health

Prevalence of mental disorders, including major depressive disorder (MDD), bipolar disorder (BD) and schizophrenia (SZ) are increasing at alarming rates in our societies. Growing evidence points toward major sex differences in these conditions, and high rates of treatment resistance support the need to consider novel biological mechanisms outside of neuronal function to gain mechanistic insights that could lead to innovative therapies. Blood-brain barrier alterations have been reported in MDD, BD and SZ. Here, we provide an overview of sex-specific immune, endocrine, vascular and transcriptional-mediated changes that could affect neurovascular integrity and possibly contribute to the pathogenesis of mental disorders. We also identify pitfalls in current literature and highlight promising vascular biomarkers. Better understanding of how these adaptations can contribute to mental health status is essential not only in the context of MDD, BD and SZ but also cardiovascular diseases and stroke which are associated with higher prevalence of these conditions.

Sex and Age Differences in Anxiety and Depression Levels Before and After Aerobic Interval Training in Cardiac Rehabilitation

PURPOSE

The objective of this study was to investigate sex and age differences in anxiety and depression among patients with cardiovascular disease at baseline and following aerobic interval training (AIT)-based cardiac rehabilitation (CR) and secondarily to compare dropout rates between sexes and age groups.

METHODS

Participants were younger (≤44 yr), middle-aged (45-64 yr), and older adults (≥65 yr). The AIT protocol consisted of: 4 × 4-min of high-intensity work periods at 85-95% peak heart rate (HR) interspersed with 3 min of lower-intensity intervals at 60-70% peak HR, twice weekly for 10 wk. Anxiety and depression were assessed using the Hospital Anxiety and Depression Scale at baseline and following CR.

RESULTS

At baseline, of 164 participants (32% female), 14 (35% female) were younger, 110 (33% female) were middle-aged, and 40 (30% female) were older. Older adults reported lower anxiety levels versus younger (4.4 ± 2.6 vs 7.8 ± 3.4 points, P = .008) and middle-aged adults (4.4 ± 2.6 vs 6.1 ± 3.6 points, P = .05). Baseline depression levels did not differ between age groups (P = .749). All age groups experienced a reduction in anxiety (younger =-2.67; middle-aged =-1.40; older =-0.85) and depression (younger =-1.50; middle-aged =-0.83; older =-0.70) levels following CR. Differences in dropout rates were observed between age groups (χ2[1] = 13.4, P = .001). Within each age group, 43% (female n = 2, male n = 4) of younger, 10% (female n = 8, male n = 3) of middle-aged, and 2.5% (female n = 0, male n = 1) of older participants dropped out.

CONCLUSIONS

Younger and middle-aged adults experience higher levels of anxiety upon entry into CR compared with older adults. Cardiac rehabilitation was associated with significant reductions in anxiety and depression severity, yet dropout rates were highest among younger adults.

Increased risk of ischemic heart disease in patients with bipolar disorder: A population-based study

OBJECTIVE

This study investigated the national prevalence and incidence of ischemic heart disease and associated factors among Taiwanese patients with bipolar disorder.

METHODS

We used a random sample of 766,427 subjects who were ≥18 years old from the National Health Research Institute database in 2005. Subjects with at least one primary diagnosis of bipolar disorder or ischemic heart disease were identified. We compared the prevalence and incidence of ischemic heart disease in bipolar patients and the general population in 2005 and the same cohort from 2006 to 2010. These associated factors with respect to ischemic heart disease among patients with bipolar disorder were also analyzed.

RESULTS

The prevalence of ischemic heart disease in patients with bipolar disorder was 1.69 times higher than in the general population (7.85% vs 4.67%; odds ratio 1.69; 95% confidence interval, 1.41-2.03) in 2005. The average annual incidence of ischemic heart disease in patients with bipolar disorder was also 1.60 times higher than in the general population (2.02% vs 1.24; risk ratio 1.60; 95% confidence interval, 1.36-1.90) from 2006 to 2010. The higher prevalence of ischemic heart disease among bipolar patients was associated with increased age, diabetes, hypertension, and antidepressant use.

CONCLUSIONS

Patients with bipolar disorder had a significantly higher prevalence and incidence of ischemic heart disease than the general population in both sexes, especially at younger ages. Among patients with bipolar disorder, older age, and hyperlipidemia were risk factors of ischemic heart disease.

Anxiety as a risk factor for cardiovascular disease independent of depression: A narrative review of current status and conflicting findings

The aim of this paper is to summarise and evaluate the empirical support for the association between anxiety and cardiovascular disease (CVD) and to address challenges related to method and study design. We review results from meta-analyses and more recent findings on the association of anxiety and the risk of CVD. Depression and anxiety are often listed as psychosocial risk markers of CVD, but the role of anxiety as a risk factor for CVD has not received the same evidential support as the effects of depression. Through a narrative review we identified six meta-analyses as well as 15 recent large studies of anxiety and CVD that we summarise. Some of the conflicting findings may be artefacts of study design or population the sample is drawn from. Researchers should take care to be population specific, measurement specific and outcome specific, and to control for comorbid depression.

Depression and cardiovascular disease: Shared molecular mechanisms and clinical implications

Depression is a highly prevalent risk factor for both the onset of cardiovascular disease (CVD) and the mortality of CVD patients, and people suffering from CVD are more likely to develop depression than healthy individuals. The aim of this review is to summarize recent findings regarding the underlying relationship between CVD and depression. Literature search and review were conducted using PubMed, Google Scholar, Wanfang Med Online, and Baidu Scholar databases. CVD and depression are intimately related and researchers from around the world have proposed and validated various mechanisms that may potentially explain the comorbidity of CVD and depression. Recent studies have suggested that depression and CVD may manifest as two distinct clinical conditions in two different organs, the brain and the heart, respectively, but may also be linked by shared mechanisms. Of these, inflammation involving the immune system is thought to be a common mechanism of depression and heart disease, with specific inflammatory cytokines or pathways being potential targets for the prevention and treatment of the concurrent diseases. Therefore, inflammation may play an important role in bridging the link between depression and CVD, a finding that can have important clinical implications for the prevention and early intervention of these conditions.

Early Emotional Symptoms Predicting Carotid Atherosclerosis in Youth: Results From a Birth Cohort in Latin America

Background

Emotional disorders are risk factors for atherosclerosis and consequent cardiovascular disease. However, it is not clear whether emotional symptoms (ESs) have direct effects on cardiovascular disease. The aim of the present study is to investigate the effects of early ESs on carotid atherosclerosis in young adults.

Methods and Results

We tested the association between expression of ESs at 11 and 15 years of age and carotid intima‐media thickness at 18 years of age in the 1993 Pelotas Birth Cohort (N=5249, n=4336 with complete mental health data). ESs were assessed using the Strengths and Difficulties Questionnaire. Propensity score weighting procedure was run using generalized boosted regression model to adjust for potential confounding between exposure and outcome. We also tested whether traditional cardiovascular risk factors could mediate this relationship. Adjusted high expression of ESs, both at 11 and 15 years of age, led to mean increases in carotid intima‐media thickness of 1.84 and 2.58 μm, respectively, at 18 years of age (both P<0.001). Longitudinal effects of ESs on atherosclerosis were direct and not significantly mediated by traditional cardiovascular risk factors. Male sex at age 15 years significantly enhanced the effects of ESs on carotid intima‐media thickness at age 18 years (P<0.001 for interaction): although high expression of ESs led to mean increases of 1.14 μm in females (P<0.05), it led to mean increases of 5.83 μm in males (P<0.001).

Conclusions

In this large birth cohort, expression of ESs in adolescence was longitudinally associated with a higher carotid intima‐media thickness in young adults. The association is direct and not mediated by traditional cardiovascular risk factors. Interactions by sex might have important implications for designing future interventions.

Effects of a mental stress challenge on brain function in coronary artery disease patients with and without depression

OBJECTIVE

Coronary artery disease (CAD) patients with comorbid depression show an increase in mortality compared to cardiac patients without depression, but the mechanisms mediating this effect remain obscure. One possible explanation for this finding is that depressed patients with CAD exhibit an increased vulnerability to stress. The purpose of this study was to assess the effects of stress and depression on brain function and to explore its relationship with myocardial ischemia in CAD patients.

METHODS

Patients with CAD and depression (N = 13) and CAD without depression (N = 15) underwent imaging of the brain with positron emission tomography and [O-15] water and imaging of the heart with single photon emission computed tomography (SPECT) and [Tc-99m] sestamibi under mental stress task and control conditions.

RESULTS

CAD patients with depression compared to nondepressed showed decreased function with mental stress in the rostral anterior cingulate, the hippocampus, parts of the dorsolateral temporal and parietal cortex, the cerebellum, and the uncus, with increased blood flow in the parahippocampus, visual association cortex, and posterior cingulate. Depressed CAD patients who became ischemic during a mental stress task had relative decreases in the caudal and posterior cingulate, orbitofrontal cortex, and cerebellum, and increased activation in the parietal cortex and precuneus/visual association cortex compared to nonischemic depressed CAD patients.

CONCLUSIONS

These findings are consistent with dysfunction in a network of brain regions involved in the stress response in patients with comorbid CAD and depression that has direct and indirect links to the heart, suggesting a pathway by which stress and depression could lead to increased risk of heart disease related morbidity and mortality. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Exercise as a prescription for patients with various diseases

A growing understanding of the benefits of exercise over the past few decades has prompted researchers to take an interest in the possibilities of exercise therapy. Because each sport has its own set of characteristics and physiological complications that tend to occur during exercise training, the effects and underlying mechanisms of exercise remain unclear. Thus, the first step in probing the effects of exercise on different diseases is the selection of an optimal exercise protocol. This review summarizes the latest exercise prescription treatments for 26 different diseases: musculoskeletal system diseases (low back pain, tendon injury, osteoporosis, osteoarthritis, and hip fracture), metabolic system diseases (obesity, type 2 diabetes, type 1 diabetes, and nonalcoholic fatty liver disease), cardio-cerebral vascular system diseases (coronary artery disease, stroke, and chronic heart failure), nervous system diseases (Parkinson's disease, Huntington's disease, Alzheimer's disease, depression, and anxiety disorders), respiratory system diseases (chronic obstructive pulmonary disease, interstitial lung disease, and after lung transplantation), urinary system diseases (chronic kidney disease and after kidney transplantation), and cancers (breast cancer, colon cancer, prostate cancer, and lung cancer). Each exercise prescription is displayed in a corresponding table. The recommended type, intensity, and frequency of exercise prescriptions are summarized, and the effects of exercise therapy on the prevention and rehabilitation of different diseases are discussed.

Risk factors for developing depression in women with cervical cancer: a nationwide population-based study in Taiwan

Introduction

Depression might affect women with cervical cancer and can deteriorate their quality of life or even their compliance with cancer treatments. The aim of this study was to investigate the incidence of depression and risk factors for developing depression among women with cervical cancer in Taiwan.

Patients and methods

This study enrolled patients with newly diagnosed cervical cancer from the National Health Insurance Research Database in Taiwan. From a population of 21,400,826 residents, each cervical cancer patient was matched with one subject without cervical cancer according to sex, age, and comorbidities with the same diagnostic index. The International Classification of Diseases, Ninth Revision, code 180.9 was used to identify patients with cervical cancer, and 296.0X–296.1X, 296.4X–296.8X, 296.2X–296.3X, 300.4, and 311.X codes were used to identify those with depressive disorders.

Results

In total, 19,316 newly diagnosed cervical cancer patients were enrolled from January 2000 to December 2005, and the median follow-up period was 5.23 years (1.75–8.48 years). The prevalence of depressive disorder was 4.21% (813 of 19,316) in the cervical cancer cohort, and it was 3.85% (744 of 19,316) in the control cohort. The incidence risk ratio of depressive disorders was 1.35 (95% CI =1.22–1.49, P<0.001) among these cervical cancer patients. Cervical cancer, as an independent risk factor, was associated with developing subsequent depressive disorder. In addition, being older (≥65 years old) and the comorbidities of diabetes mellitus, ischemic heart disease, and cerebrovascular disease were also risk factors for predicting depressive disorder in cervical cancer patients.

Discussion

Cervical cancer is a prominent risk factor for the development of depression in women with cervical cancer in Taiwan. The patients with comorbidities, including diabetes mellitus, ischemic heart disease, and cerebrovascular disease, have higher risks of developing depression. However, there were no significant differences among the cervical cancer treatment modalities. In conclusion, these patients require early psychological support and intervention.

National Survey of Morbidity and Risk Factors (EMENO): Protocol for a Health Examination Survey Representative of the Adult Greek Population

Background

Main causes of death in Greece are cardiovascular diseases (CVDs), malignant neoplasms, respiratory diseases, and road traffic crashes. To assess the population health status, monitor health systems, and adjust policies, national population-based health surveys are recommended. The previous health surveys that were conducted in Greece were restricted to specific regions or high-risk groups.

Objective

This paper presents the design and methods of the Greek Health Examination Survey EMENO (National Survey of Morbidity and Risk Factors). The primary objectives are to describe morbidity (focusing on CVD, respiratory diseases, and diabetes), related risk factors, as well as health care and preventive measures utility patterns in a random sample of adults living in Greece.

Methods

The sample was selected by applying multistage stratified random sampling on 2011 Census. Trained interviewers and physicians made home visits. Standardized questionnaires were administered; physical examination, anthropometric and blood pressure measurements, and spirometry were performed. Blood samples were collected for lipid profile, glucose, glycated hemoglobin, and transaminases measurements. The survey was conducted from May 2013 until June 2016.

Results

In total, 6006 individuals were recruited (response rate 72%). Of these, 4827 participated in at least one physical examination, 4446 had blood tests, and 3622 spirometry, whereas 3580 provided consent for using stored samples for future research (3528 including DNA studies). Statistical analysis has started, and first results are expected to be submitted for publication by the end of 2018.

Conclusions

EMENO comprises a unique health data resource and a bio-resource in a Mediterranean population. Its results will provide valid estimates of morbidity and risk factors’ prevalence (overall and in specific subdomains) and health care and preventive measures usage in Greece, necessary for an evidence-based strategy planning of health policies and preventive activities.

International Registered Report Identifier (IRRID)

DERR1-10.2196/10997

Depressive Symptoms During Childhood and Cardiovascular Risk Factors in Black and White Men

OBJECTIVE

Depressive symptoms and major depression predict cardiovascular disease (CVD) and CVD risk factors in adulthood. Evidence regarding the role of depression in the development of CVD risk in youth is minimal. The study evaluated the prospective relationship of depressive symptoms in childhood and adolescence with adult CVD risk factors in black and white men.

METHODS

Health behaviors and medical history were measured in 165 black and 146 white men (mean age = 32); a subset in the Pittsburgh area had a fasting blood draw to measure metabolic syndrome and inflammation. Adult CVD risk factors were related to depressive symptoms and childhood socioeconomic status (SES) prospectively measured annually from ages 7 to 16 years, followed by adjustments for adult SES and depressive symptoms.

RESULTS

Men with higher depressive symptoms ages 7 to 16 smoked more cigarettes, B = 0.28 (standard error = 0.12), p = .015, and ate fewer servings of fruits and vegetables, B = -0.08 (0.04), p = .040, as adults. The association for smoking was independent of adult depressive symptoms (concurrent) and childhood and adult SES as well as race. Depressive symptoms during childhood were unrelated to the metabolic syndrome or biomarkers of inflammation in adulthood.

CONCLUSIONS

Depressive symptoms in childhood may predict later adverse health behaviors in black and white men. No evidence was found for an association between childhood depressive symptoms with metabolic syndrome or inflammation markers at ages approximately 32 years. The nature of the sample and lack of measurement of depressive disorder diagnosis tempers the conclusions, and future research is needed to determine associations with biological measures at later life span phases.

Depressive disorders among patients with gastric cancer in Taiwan: a nationwide population-based study

BACKGROUND

In cancer patients, depressive disorder comorbidity is associated with greater suicide risk and poorer treatment outcomes, quality of life, and adherence to treatment. The aim of the study was to evaluate the incidence of newly-diagnosed depressive disorders after a gastric cancer diagnosis compared with a matched cohort using the National Health Insurance Research Database in Taiwan.

METHODS

We conducted a retrospective cohort study of 57,506 patients (28,753 patients with gastric cancer and 28,753 matched patients) selected from the National Health Insurance Research Database. Patients were observed for a maximum of 12 years to determine the incidence of newly-diagnosed depressive disorders. Also, a Cox regression analysis which included death as an independent censor was performed to identify the potentially predictive variables for developing subsequent depressive disorders following a cancer diagnosis among the patients suffering from gastric cancer.

RESULTS

The cumulative incidence of depressive disorders in the gastric cancer patients was significantly higher compared to those in the matched cohort (p < .001). The adjusted hazard ratio was 1.54 (95% confidence interval, CI = 1.39-1.70, P < .001) in the gastric cancer cohort compared with the matched cohort. Independent predictive variables for developing subsequent depressive disorders among the patients with gastric cancer included female sex and hypertension.

CONCLUSIONS

In the study, higher incidence of new-onset depression, being defined by the records of the diagnostic codes combining antidepressants use in a nationwide database, was noted in the gastric cancer patients compared with the matched cohort. In addition, female sex and comorbid hypertension may be predictive variables for the subsequent depression among the patients with gastric cancer. Further clinical prospective studies were necessary to confirm these findings.

Anxiety and depression are associated with long-term outcomes of hepatocellular carcinoma: A nationwide study of a cohort from Taiwan

OBJECTIVES

A natural experimental design was coupled with propensity score matching to assess the risks of anxiety and depression and to assess the longitudinal effects of anxiety and depression on healthcare utilisation and mortality in hepatocellular carcinoma (HCC) patients.

METHODS

This nationwide population-based cohort study retrospectively analysed 7304 patients treated for HCC during 1996-2010. Generalised estimating equations were used to estimate differences-in-differences models for examining the effects of anxiety and depression disorders.

RESULTS

Independent risk factors for anxiety and depression in the HCC patients were female gender (hazard ratio (HR) 1.45; P < 0.001), Charlson co-morbidity index score (HR 1.12; P = 0.005), and liver cirrhosis (HR 1.35; P = 0.004). Anxiety and depression (differences-in-differences value) had a significant (P < 0.001) positive net effect on number of physician visits. Furthermore, the mean overall survival time was 83.4 months (SD 5.4 months) in the anxiety/depression group and 65.4 months (SD 4.8 months) in the non-disorder group. Additionally, the overall survival rate was significantly higher in the anxiety/depression group compared to the non-disorder group during the study period (P = 0.003).

CONCLUSIONS

Anxiety disorders and depression disorders are associated with a significantly increased overall survival rate in HCC patients. However, further studies are needed to investigate this association.

Relationships of Anxiety and Depression with Cardiovascular Health in Youth with Normal Weight to Severe Obesity

OBJECTIVE

To evaluate the relationships of depression and anxiety symptoms with cardiovascular disease (CVD) risk factors and measures of vascular health in youth.

STUDY DESIGN

Participants (n = 202) were 8- to 18-year-olds from a cross-sectional study evaluating cardiovascular health across a wide range of body mass index values (normal weight to severe obesity). CVD risk measurement included blood pressure, fasting lipids, glucose, insulin, carotid artery intima-media thickness, compliance and distensibility, brachial artery flow-mediated dilation, carotid-radial artery pulse wave velocity, body fat percentage, and a metabolic syndrome cluster score. Anxiety and depression symptoms were self-reported on the Screen for Child Anxiety Related Disorders and Center for Epidemiological Studies Depression Scale for Children. Two sets of adjustment variables were used in evaluation of differences between those with and without anxiety or depression symptomatology for the CVD risk factor and vascular outcomes. The first set included adjustment for Tanner stage, sex, and race; the second was additionally adjusted for percent body fat.

RESULTS

Anxiety was not significantly associated with CVD risk factors or vascular health in either model. Depression was associated with high-density lipoprotein cholesterol, triglycerides, and metabolic syndrome cluster score; these relationships were attenuated when accounting for percent body fat.

CONCLUSIONS

When accounting for body fat, we found no clear relationship of self-reported depression or anxiety symptoms with CVD risk factors or vascular health in youth.

Depression, anxiety, and stress in patients with coronary heart disease

The analytical paper summarized the results of recent studies of an association of depression, anxiety, and stress with coronary heart disease (CHD). Mental disorders are shown to be associated with increased risk of CHD and to worsen the course of coronary disease. Antidepressants and psychotherapy improve the control of mental disorders, quality of life, and, in some cases, have a positive impact on the course of coronary disease.

Prevalence, incidence and mortality from cardiovascular disease in patients with pooled and specific severe mental illness: a large-scale meta-analysis of 3,211,768 patients and 113,383,368 controls

People with severe mental illness (SMI) - schizophrenia, bipolar disorder and major depressive disorder - appear at risk for cardiovascular disease (CVD), but a comprehensive meta-analysis is lacking. We conducted a large-scale meta-analysis assessing the prevalence and incidence of CVD; coronary heart disease; stroke, transient ischemic attack or cerebrovascular disease; congestive heart failure; peripheral vascular disease; and CVD-related death in SMI patients (N=3,211,768) versus controls (N=113,383,368) (92 studies). The pooled CVD prevalence in SMI patients (mean age 50 years) was 9.9% (95% CI: 7.4-13.3). Adjusting for a median of seven confounders, patients had significantly higher odds of CVD versus controls in cross-sectional studies (odds ratio, OR=1.53, 95% CI: 1.27-1.83; 11 studies), and higher odds of coronary heart disease (OR=1.51, 95% CI: 1.47-1.55) and cerebrovascular disease (OR=1.42, 95% CI: 1.21-1.66). People with major depressive disorder were at increased risk for coronary heart disease, while those with schizophrenia were at increased risk for coronary heart disease, cerebrovascular disease and congestive heart failure. Cumulative CVD incidence in SMI patients was 3.6% (95% CI: 2.7-5.3) during a median follow-up of 8.4 years (range 1.8-30.0). Adjusting for a median of six confounders, SMI patients had significantly higher CVD incidence than controls in longitudinal studies (hazard ratio, HR=1.78, 95% CI: 1.60-1.98; 31 studies). The incidence was also higher for coronary heart disease (HR=1.54, 95% CI: 1.30-1.82), cerebrovascular disease (HR=1.64, 95% CI: 1.26-2.14), congestive heart failure (HR=2.10, 95% CI: 1.64-2.70), and CVD-related death (HR=1.85, 95% CI: 1.53-2.24). People with major depressive disorder, bipolar disorder and schizophrenia were all at increased risk of CVD-related death versus controls. CVD incidence increased with antipsychotic use (p=0.008), higher body mass index (p=0.008) and higher baseline CVD prevalence (p=0.03) in patients vs.

CONTROLS

Moreover, CVD prevalence (p=0.007), but not CVD incidence (p=0.21), increased in more recently conducted studies. This large-scale meta-analysis confirms that SMI patients have significantly increased risk of CVD and CVD-related mortality, and that elevated body mass index, antipsychotic use, and CVD screening and management require urgent clinical attention.

The Effects of an Exercise Program on Anxiety Levels and Metabolic Functions in Patients With Anxiety Disorders

The purpose of this study was to evaluate the effects of a home-based (HB) exercise program on anxiety levels and metabolic functions in patients with anxiety disorders in Taiwan. Purposive sampling was used to recruit 86 participants for this randomized, experimental study. Participants were asked to complete a pretest before the 3-month exercise program, a posttest at 1 week, and a follow-up test at 3 months after the exercise program. Study measures included four Self-Report Scales and biophysical assessments to collect and assess personal data, lifestyle behaviors, anxiety levels, and metabolic control functions. Of the 86 study participants, 83 completed the posttest and the 3-month follow-up test, including 41 in the experimental group and 42 in the control group. Participants in the experimental group showed significant improvements in body mass index, high-density lipoprotein cholesterol levels, and the level of moderate exercise after the program relative to the control group, as analyzed by generalized estimating equations mixed-model repeated measures. State and trait anxiety levels were also significantly improved from pretest to follow-up test in the experimental group. Finally, the prevalence of metabolic syndrome declined for participants in the experimental group. The HB exercise program produced positive effects on the metabolic indicators and anxiety levels of Taiwanese adults with anxiety disorders. Health providers should consider using similar HB exercise programs to help improve the mental and physical health of patients with anxiety disorders in their communities.

Behavioral, emotional and neurobiological determinants of coronary heart disease risk in women

Women have more of the stress-related behavioral profile that has been linked to cardiovascular disease than men. For example, women double the rates of stress-related mental disorders such as depression and posttraumatic stress disorder (PTSD) than men, and have higher rates of exposure to adversity early in life. This profile may increase women's long-term risk of cardiometabolic conditions linked to stress, especially coronary heart disease (CHD). In addition to having a higher prevalence of psychosocial stressors, women may be more vulnerable to the adverse effects of these stressors on CHD, perhaps through altered neurobiological physiology. Emerging data suggest that young women are disproportionally susceptible to the adverse effects of stress on the risk of cardiovascular disease, both in terms of initiating the disease as well as worsening the prognosis in women who have already exhibited symptoms of the disease. Women's potential vulnerability to psychosocial stress could also help explain their higher propensity toward abnormal coronary vasomotion and microvascular disease compared with men.

The Association between Baseline Subjective Anxiety Rating and Changes in Cardiac Autonomic Nervous Activity in Response to Tryptophan Depletion in Healthy Volunteers

The aim of this study was to investigate the influence of serotonin on anxiety and autonomic nervous system (ANS) function; the correlation between subjective anxiety rating and changes of ANS function following tryptophan depletion (TD) in healthy volunteers was examined. Twenty-eight healthy participants, consisting of 15 females and 13 males, with an average age of 33.3 years, were recruited.Baseline Chinese Symptom Checklist-90-Revised and ANS function measurements were taken. TD was carried out on the testing day, and participants provided blood samples right before and 5 hours after TD. ANS function, somatic symptoms, and Visual Analogue Scales (VASs) were determined after TD. Wilcoxon signed rank test and Spearman ρ correlation were adapted for analyses of the results.The TD procedure reduced total and free plasma tryptophan effectively. After TD, the sympathetic nervous activity increased and parasympathetic nervous activity decreased. Baseline anxiety ratings positively correlated with post-TD changes in sympathetic nervous activity, VAS ratings, and physical symptoms. However, a negative correlation with post-TD changes in parasympathetic nervous activity was found.The change in ANS function after TD was associated with the severity of anxiety in healthy volunteers. This supports the fact that the effect of anxiety on heart rate variability is related to serotonin vulnerability. Furthermore, it also shows that the subjective anxiety rating has a biological basis related to serotonin.

Anxiety as a risk factor in cardiovascular disease

PURPOSE OF REVIEW

The narrative review covers recent studies of anxiety as a companion in cardiovascular disease.

RECENT FINDINGS

Prospective population-based studies and studies of cases with known cardiovascular disease have been conducted, as well as studies of intervention with coronary bypass grafting, heart transplants, and implantable cardioverter-defibrillators, and subsequent rehabilitation programs. Mental stress-induced myocardial ischemia (MSIMI) stands for this emerging research arena.

SUMMARY

Anxiety has emerged as perhaps the most important risk factor for cardiovascular disease, determining other known risk factors, such as depression, substance use, overweight, and a sedentary lifestyle. Anxiety also increases the risk of major cardiac events in coronary heart disease. There is a need for elucidating the influence of anxiety in takotsubo and in white-coat hypertension. Managing anxiety is of vital importance in patients who have received heart transplants, to ascertain adherence to immunosuppressants.

Major Depressive Disorder and Bipolar Disorder Predispose Youth to Accelerated Atherosclerosis and Early Cardiovascular Disease: A Scientific Statement From the American Heart Association

In the 2011 "Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents," several medical conditions among youth were identified that predispose to accelerated atherosclerosis and early cardiovascular disease (CVD), and risk stratification and management strategies for youth with these conditions were elaborated. Major depressive disorder (MDD) and bipolar disorder (BD) among youth satisfy the criteria set for, and therefore merit inclusion among, Expert Panel tier II moderate-risk conditions. The combined prevalence of MDD and BD among adolescents in the United States is ≈10%, at least 10 times greater than the prevalence of the existing moderate-risk conditions combined. The high prevalence of MDD and BD underscores the importance of positioning these diseases alongside other pediatric diseases previously identified as moderate risk for CVD. The overall objective of this statement is to increase awareness and recognition of MDD and BD among youth as moderate-risk conditions for early CVD. To achieve this objective, the primary specific aims of this statement are to (1) summarize evidence that MDD and BD are tier II moderate-risk conditions associated with accelerated atherosclerosis and early CVD and (2) position MDD and BD as tier II moderate-risk conditions that require the application of risk stratification and management strategies in accordance with Expert Panel recommendations. In this scientific statement, there is an integration of the various factors that putatively underlie the association of MDD and BD with CVD, including pathophysiological mechanisms, traditional CVD risk factors, behavioral and environmental factors, and psychiatric medications.

Association between history of psychosis and cardiovascular disease in bipolar disorder

OBJECTIVES

To determine whether clinical features of bipolar disorder, such as history of psychosis, and cardiovascular disease (CVD) risk factors contribute to a higher risk of CVD among patients with bipolar disorder.

METHODS

This cross-sectional study included a sample of 988 patients with bipolar I or bipolar II disorder or schizoaffective bipolar type confirmed by the Structured Clinical Interview for DSM-IV-TR disorders (SCID). Medical comorbidity burden was quantified utilizing the Cumulative Illness Severity Rating Scale (CIRS). This 13-item organ-based scale includes cardiac disease severity quantification. Confirmed by medical record review, patients who scored 1 (current mild or past significant problem) or higher in the cardiac item were compared by logistic regression to patients who scored 0 (no impairment), adjusting for CVD risk factors that were selected using a backwards stepwise approach or were obtained from the literature.

RESULTS

In a multivariate model, age [odds ratio (OR) = 3.03, 95% confidence interval (CI): 1.66-5.54, p < 0.0001], hypertension (OR = 2.43, 95% CI: 1.69-3.55, p < 0.0001), and history of psychosis (OR = 1.48, 95% CI: 1.03-2.13, p = 0.03) were associated with CVD. When CVD risk factors from the literature were added to the analysis, age (OR = 3.19, 95% CI: 1.67-6.10, p = 0.0005) and hypertension (OR = 2.46, 95% CI: 1.61-3.76, p < 0.01) remained significant, with psychosis being at the trend level (OR = 1.43, 95% CI: 0.96-2.13, p = 0.08).

CONCLUSIONS

The phenotype of psychotic bipolar disorder may reflect higher illness severity with associated cardiac comorbidity. Further studies are encouraged to clarify the effect of the disease burden (i.e., depression), lifestyle, and treatment interventions (i.e., atypical antipsychotics) on this risk association.

Mortality of subjects with mood disorders in the Lundby community cohort: a follow-up over 50 years

AIMS

To compare causes of death and mortality among subjects with and without mood disorder in the Lundby Cohort and to analyse additional mental disorders as risk factors for mortality in subjects with mood disorders.

BACKGROUND

The Lundby study is a longitudinal study that investigated mental health in an unselected population. The study commenced in 1947; the population was further investigated in 1957, 1972, and 1997.

METHODS

Experienced psychiatrists performed semi-structured diagnostic interviews, and best estimate consensus diagnoses of mental disorders were assessed at each field investigation. Subjects with mood disorder (n=508, 195 males, 313 females) were identified until 1997. Causes and dates of death between 1947 and 2011 were obtained from the Swedish cause of death register and were compared between subjects diagnosed with mood disorder and other participants. Mortality was compared between those with mood disorders and the remaining cohort with Cox regression analyses. Other mental disorders were considered as risk factors for death for subjects with mood disorders.

RESULTS

The hazard ratio for mortality in mood disorders was HR=1.18. However, the mortality was elevated only for males, HR=1.5. Comorbid anxiety disorders, organic disorders, dementia and psychotic disorders were significant risk factors for death. A total of 6.3% of the participants with mood disorder and 1.2% of the remaining participants committed suicide.

CONCLUSIONS

As expected, the suicide rate was higher among participants with mood disorders. Only males with mood disorders had elevated mortality. The impact on mortality from other mental disorders seems to vary between the genders.

Antipsychotic drugs and risks of myocardial infarction: a self-controlled case series study

AIM

Antipsychotics increase the risk of stroke. Their effect on myocardial infarction remains uncertain because people prescribed and not prescribed antipsychotic drugs differ in their underlying vascular risk making between-person comparisons difficult to interpret. The aim of our study was to investigate this association using the self-controlled case series design that eliminates between-person confounding effects.

METHODS AND RESULTS

All the patients with a first recorded myocardial infarction and prescription for an antipsychotic identified in the Clinical Practice Research Datalink linked to the Myocardial Ischaemia National Audit Project were selected for the self-controlled case series. The incidence ratio of myocardial infarction during risk periods following the initiation of antipsychotic use relative to unexposed periods was estimated within individuals. A classical case-control study was undertaken for comparative purposes comparing antipsychotic exposure among cases and matched controls. We identified 1546 exposed cases for the self-controlled case series and found evidence of an association during the first 30 days after the first prescription of an antipsychotic, for first-generation agents [incidence rate ratio (IRR) 2.82, 95% confidence interval (CI) 2.0-3.99] and second-generation agents (IRR: 2.5, 95% CI: 1.18-5.32). Similar results were found for the case-control study for new users of first- (OR: 3.19, 95% CI: 1.9-5.37) and second-generation agents (OR: 2.55, 95% CI: 0.93-7.01) within 30 days of their myocardial infarction.

CONCLUSION

We found an increased risk of myocardial infarction in the period following the initiation of antipsychotics that was not attributable to differences between people prescribed and not prescribed antipsychotics.

Irritable brain caused by irritable bowel? A nationwide analysis for irritable bowel syndrome and risk of bipolar disorder

OBJECTIVE

We explored the association between IBS and the development of bipolar disorder, and the risk factors for bipolar disorders in patients with IBS.

METHODS

We identified patients who were newly diagnosed with IBS between 2000 and 2010 in the Taiwan National Health Insurance Research Database. We also identified a comparison matched cohort without IBS. The occurrence of new-onset bipolar disorder was evaluated in both cohorts.

RESULTS

The IBS cohort consisted of 30,796 patients and the comparison cohort consisted of 30,796 matched patients without IBS. The incidence of bipolar disorder (incidence rate ratio, 2.63, 95% confidence interval (CI) 2.10-3.31, P < .001) was higher in the IBS patients than in the matched cohort. Multivariate matched regression models indicated that autoimmune diseases (HR 1.52, 95% CI 1.07-2.17, P = .020), and asthma (HR 1.45, 95% CI 1.08-1.95, P = .013) were independent risk factors for the development of bipolar disorder in the IBS patients.

CONCLUSION

IBS may increase the risk of developing subsequent bipolar disorder. Additional prospective studies are required to confirm these findings.

The association between prostate cancer and mood disorders: a nationwide population-based study in Taiwan

BACKGROUND

This study identified possible risk factors for newly diagnosed mood disorders, including depressive and bipolar disorders, in prostate cancer patients.

METHODS

From 2000 to 2006, two cohorts were evaluated on the occurrence of mood disorder diagnosis and treatment. For the first cohort, data of patients diagnosed with prostate cancer was obtained from the Taiwan National Health Insurance (NHI) Research Database. As the second cohort, a cancer-free comparison group was matched for age, comorbidities, geographic region, and socioeconomic status.

RESULTS

Final analyses involved 12,872 men with prostate cancer and 12,872 matched patients. Increased incidence of both depressive (IRR 1.52, 95% CI 1.30-1.79, P <0.001) and bipolar disorder (IRR 1.84, 95% CI 1.25-2.74, P = 0.001) was observed among patients diagnosed with prostate cancer. Multivariate matched regression models show that cerebrovascular disease (CVD) and radiotherapy treatment could be independent risk factors for developing subsequent depressive and bipolar disorders.

CONCLUSION

We observed that the risk of developing newly diagnosed depressive and bipolar disorders is higher among Taiwanese prostate cancer patients. Clinicians should be aware of the possibility of increased depressive and bipolar disorders among prostate cancer patients in Taiwan. A prospective study is necessary to confirm these findings.

Anxiety and depressive disorders among patients with esophageal cancer in Taiwan: a nationwide population-based study

BACKGROUND

The comorbidity of depression with anxiety disorders is associated with poorer treatment outcomes, worse quality of life, poorer adherence to treatment, and greater suicide risk in cancer patients.

OBJECTIVE

To assess the risk of comorbid anxiety and depressive disorders after the diagnosis of esophageal cancer compared with a matched cohort by using the Taiwan National Health Insurance Research Database (NHIRD).

METHODS

We conducted a retrospective study of 28,454 patients (14,227 patients with esophageal cancer and 14,227 matched patients) who were selected from the NHIRD. Patients were observed for a maximum of 12 years to determine the incidence of new-onset anxiety and depressive disorders for which antidepressants had been prescribed. A Cox regression analysis was performed to identify the risk factors associated with anxiety and depressive disorders in esophageal cancer patients.

RESULTS

The cumulative incidence of anxiety and depressive disorders in the esophageal cancer patients was significantly higher than that in the matched cohort (P < .001). The adjusted hazard ratio (HR) was 2.24 (95 % confidence interval, CI = 1.95-2.56, P < .001) in the esophageal cancer cohort compared with the matched cohort. Independent risk factors for developing anxiety and depressive disorders among the patients with esophageal cancer included cirrhosis, cerebrovascular disease, and surgical treatment.

CONCLUSION

Esophageal cancer may be a prominent risk factor for anxiety and depressive disorders. Based on our data, we suggest that attention should be focused on esophageal cancer patients with comorbid cirrhosis and cerebrovascular disease and those who have received surgical interventions.

Delayed onset urticaria in depressive patients with bupropion prescription: a nationwide population-based study

Background

Bupropion, which is widely used in patients with depressive disorder, may cause allergic reactions. However, the real prevalence of these side effects may be overlooked and underreported due to the delayed onset phenomenon.

Objective

This study aimed to estimate the real incidence of bupropion-induced urticaria and clarify the delayed onset phenomenon.

Methods

We conducted a nationwide cohort study between 2000 and 2009 using Taiwan’s National Health Insurance Dataset. Among 65,988 patients with depressive disorders, we identified new users of bupropion with depressive disorders (bupropion cohort, n = 2,839) and matched them at a ratio of 1:4 regarding age and sex (non-bupropion matched cohort, n = 11,356). The risk of urticaria was compared between the two cohorts.

Results

The risk of urticaria occurrence was higher in bupropion users than in matched controls within 4 weeks of starting the medication (risk ratio 1.81; 95% confidence interval 1.28–2.54; p = 0.001). The occurrence of urticaria in the bupropion cohort were more frequent on Days 15–28 than Day 1–14 (p = 0.002). Cox proportional hazards model showed that a history of urticaria was an independent risk factor for developing bupropion-induced urticaria.

Conclusions

Of the antidepressants, bupropion may pose a higher risk of drug-induced urticaria, and this condition might be ignored due to the delayed onset phenomenon. Depressive patients with a history of urticaria are at higher risk of the adverse drug reaction. This study emphasizes the need for increased clinical awareness of this adverse outcome to bupropion use.

Risk of developing diabetes mellitus and hyperlipidemia among patients with bipolar disorder, major depressive disorder, and schizophrenia: a 10-year nationwide population-based prospective cohort study

BACKGROUND

The high comorbidity of metabolic side effects with severe mental disorders (SMDs), including bipolar disorder (BD), major depressive disorder (MDD), and schizophrenia, had gained much attention, because the excess mortality of these patients is mainly due to physical illness. However, most of these studies were with cross-sectional study design, the time course of metabolic side effects and SMD cannot be elucidated without a cohort study.

METHOD

Using a nationwide database with a large sample size and a matched control cohort study design, we enrolled patients with SMDs but without diagnoses of and medications for DM and hyperlipidemia from 1996 to 2000, and followed them to the end of 2010. We compared them with age and gender-matched controls (1:4) for the incidence of DM and hyperlipidemia.

RESULTS

The identified cases were 367 patients with BD, 417 patients with MDD, and 1993 patients with schizophrenia, with average age of 45.3 ± 14.0, 46.5 ± 13.7, and 45.9 ± 12.3, respectively. The patients with BD and schizophrenia had increased risk of initiation of anti-diabetic medications (10.1% vs. 6.3%, p=0.012; 13.3% vs. 7.2% p<0.001; respectively), and anti-hyperlipidemia medications (15.8% vs.10.5%, p=0.004; 14.2% vs.12.1%, p=0.005; respectively) than the controls. After controlling age, gender, urbanization, and income, the Cox regression model showed significantly increased risk of initiation of anti-diabetic medications among patients with BD (hazard ratio (HR) of 1.702, 95% confidence interval (CI): 1.155-2.507) and schizophrenia (HR of1.793, 95% CI: 1.532-2.098). Increased risk of initiation of anti-hyperlipidemia medications was also noted among patients with BD (HR of 1.506, 95% CI: 1.107-2.047) and schizophrenia (HR of 1.154, 95% CI: 1.002-1.329). The patients with MDD did not show increased risk of initiation of these medications than the controls.

CONCLUSIONS

This first 10-year nationwide population-based prospective matched control cohort study showed increased risks of initiation of anti-diabetic and anti-hyperlipidemia medications among patients with BD and schizophrenia. No significant increased risk was noted among the patients with MDD.

Incidence and risk of mood disorders in patients with breast cancers in Taiwan: a nationwide population-based study

OBJECTIVE

The objective of this study is to assess the incidence and risk of mood disorders, including major depression, anxiety, and bipolar disorders, in Taiwanese patients after the diagnosis of breast cancer compared with a matched cohort.

METHODS

From January 2000 to December 2005, 26,629 newly diagnosed breast cancer patients were enrolled by the Taiwan National Health Insurance program database. The control cohort was selected randomly from 1,000,000 National Health Insurance beneficiaries from a population of 21,400,826 enrolled throughout Taiwan. Each patient was matched with one subject without breast cancer by age, sex, and presence of comorbidities with the same diagnosis index date. The diagnosis of mood disorders was defined by compatible International Classification of Diseases, 9th revision, clinical modification codes plus the prescription of antidepressants for at least 30 days.

RESULTS

The overall incidence rate ratio of mood disorders was 1.33 (95% CI 1.28-1.39, p < 0.001) in the breast cancer cohort compared with the matched cohort. The incidence rate ratios for specific mood disorders were 2.06 for bipolar disorder (95% CI 1.37-3.15 p = 0.0003), 1.94 for major depressive disorder (95% CI 1.76-2.13 p < 0.001), and 1.22 for anxiety (95% CI 1.16-1.27 p < 0.001). Independent risk factors for developing mood disorders included breast cancer, as well as age, hypertension, chronic obstructive pulmonary disease, autoimmune disease, ischemic heart disease, and cerebrovascular disease.

CONCLUSIONS

Breast cancer is a prominent risk factor for mood disorders, including major depressive disorder, anxiety, and bipolar disorder. The impact is most potent in the first year after diagnosis. Psychological support is a critical issue in these patients.

Long-term association between leisure-time physical activity and changes in happiness: analysis of the Prospective National Population Health Survey

Happiness is among the most fundamental of all human goals. Although the short-term association between physical activity and happiness is well known, the long-term associations are not. Data from the National Population Health Survey cycles conducted between 1994/1995 and 2008/2009 (cycles 1 through 8) were analyzed. Happy respondents were classified as physically active or inactive at baseline and then were followed up in subsequent cycles to examine their likelihood of becoming unhappy. Individuals who changed their activity level also were examined. After controlling for potential confounding factors, the authors found that leisure-time physical activity (LTPA) was associated with reduced odds of unhappiness after 2 years and 4 years. People who were inactive in 2 consecutive cycles were more than twice as likely to be unhappy as those who remained active in both cycles after 2 years. Compared with those who became active, inactive participants who remained inactive were also more likely to become unhappy. A change in LTPA from active to inactive was associated with increased odds of becoming unhappy 2 years later. This study suggests that LTPA has a long-term association with happiness. Changes in LTPA are associated with subsequent mood status.

Patient experiences of taking antidepressants for depression: a secondary qualitative analysis

BACKGROUND

Depression is one of the most commonly encountered mental health problems leading to significant morbidity and mortality and high medical and societal costs. Antidepressant prescribing in the UK has more than doubled in the last decade. There are a variety of factors that have been shown to affect a patient's experience of taking antidepressants The aim of this research was to explore patient narratives interviews about depression and its treatment in order to improve patient and health professional understanding of what it is like to use antidepressants.

METHODS

This study involved a supplementary secondary qualitative analysis of 80 in-depth narrative interviews from Healthtalkonline. Patients' experiences of using medicines for depression were explored in the context of their social, occupational and emotional impact, to identify any additional issues and to clarify what type of information people want to find after being prescribed a medicine. The interviews were conducted by the University of Oxford and had received ethical approval and been consented and copyrighted for this purpose. Data were analyzed thematically.

RESULTS

The most prominent theme was the coexistence of several conflicting issues around the use of medicines and participants were mostly influenced by the reality of their experiences, beliefs, attitudes and interaction with health care. Antidepressants appear to occupy a central place in many people' lives. Many people described how their medicines had helped them and how this served as a reinforcement to continue taking them in order to maintain a "normal life." Those who had stopped taking their antidepressants were likely to have experienced adverse reactions and had unsatisfactory interactions with health care professionals. A lack of information about antidepressants was a major cause of dissatisfaction often shaping attitudes to antidepressants'.

CONCLUSIONS

People's experiences with antidepressant use have a major impact on treatment continuation and hence treatment outcomes. Further studies are needed on depressed patients' beliefs about their depression and treatment and how they relate to different stages of illness, their interactions with health care and their adherence to antidepressants.

The association between antipsychotic agents and the risk of myocardial infarction: a systematic review

AIM

Patient populations that are prescribed antipsychotic agents have higher cardiovascular mortality rates. The risk of myocardial infarction is influenced by various factors that are more prevalent in patients with a mental illness. The aim of this review was to determine whether the use of antipsychotic agents is associated with the incidence of myocardial infarction in adults.

METHODS

Using multiple sources, all studies of antipsychotic agents using myocardial infarction as primary or secondary outcome measures were considered for inclusion. Study populations were adult subjects who had been prescribed an antipsychotic agent at least once in their medical history.

RESULTS

It total, five studies were identified. Four studies with small numbers of events reported a moderate to strong effect of typical antipsychotic agents on the risk of myocardial infarction. The largest study had a favourable internal validity compared with all other studies and reported no association between the risk of myocardial infarction and current use of either atypical (relative risk 0.98, 95% confidence interval [CI] 0.88, 1.09) or typical antipsychotic agents (relative risk 0.99, 95% CI 0.96, 1.03).

CONCLUSION

Clinical and methodological heterogeneity between the studies in this review led to an inconclusive answer to the question whether the use of antipsychotics is associated with the incidence of myocardial infarction in adults. Whilst results conflicted, the largest study did not find an association between the use of antipsychotic agents and an increased risk of myocardial infarction.

Association between antidepressant resistance in unipolar depression and subsequent bipolar disorder: cohort study

BACKGROUND

People with major depressive disorder who fail to respond to adequate trials of antidepressant treatment may harbour hidden bipolar disorder.

AIMS

We aimed to compare the rates of a change in diagnosis to bipolar disorder among people with major depressive disorder with stratified responses to antidepressants during an 8-year follow-up period.

METHOD

Information on individuals with major depressive disorder identified during 2000 (cohort 2000, n = 1485) and 2003 (cohort 2003, n = 2459) were collected from a nationally representative cohort of 1,000,000 health service users in Taiwan. Participants responding well to antidepressants were compared with those showing poor responses to adequate trials of antidepressants.

RESULTS

In 7.6-12.1% of those with a diagnosis of unipolar major depressive disorder this diagnosis was subsequently changed to bipolar disorder, with a mean time to change of 1.89-2.98 years. Difficult-to-treat participants presented higher rates of change to a bipolar diagnosis (25.6% in cohort 2000; 26.6% in cohort 2003) than easy-to-treat participants (8.8-8.9% in cohort 2000; 6.8-8.6% in cohort 2003; P<0.0001). Regression analysis showed that the variable most strongly associated with the change in diagnosis was antidepressant use history. The difficult-to-treat participants were associated most with diagnostic changing (cohort 2000: odds ratio (OR) = 1.88 (95% CI 1.12-3.16); cohort 2003: OR = 4.94 (95% CI 2.81-8.68)).

CONCLUSIONS

This is the first large-scale study to report an association between antidepressant response history and subsequent change in diagnosis from major depressive disorder to bipolar disorder. Our findings support the view that a history of poor response to antidepressants in unipolar depression could be a useful predictor for bipolar diathesis.

Multiple aberrations in shared inflammatory and oxidative & nitrosative stress (IO&NS) pathways explain the co-association of depression and cardiovascular disorder (CVD), and the increased risk for CVD and due mortality in depressed patients

There is evidence that there is a bidirectional relationship between major depression and cardiovascular disorder (CVD): depressed patients are a population at risk for increased cardiac morbidity and mortality, and depression is more frequent in patients who suffer from CVD. There is also evidence that inflammatory and oxidative and nitrosative stress (IO&NS) pathways underpin the common pathophysiology of both CVD and major depression. Activation of these pathways may increase risk for both disorders and contribute to shared risk. The shared IO&NS pathways that may contribute to CVD and depression comprise the following: increased levels of pro-inflammatory cytokines, like interleukin-1β (IL-1β), IL-2, IL-6, IL-8, IL-12, tumor necrosis factor-α, and interferon-γ; T cell activation; increased acute phase proteins, like C-reactive protein, haptoglobin, fibrinogen and α1-antitrypsin; complement factors; increased LPS load through bacterial translocation and subsequent gut-derived inflammation; induction of indoleamine 2,3-dioxygenase with increased levels of tryptophan catabolites; decreased levels of antioxidants, like coenzyme Q10, zinc, vitamin E, glutathione and glutathione peroxidase; increased O&NS characterized by oxidative damage to low density lipoprotein (LDL) and phospholipid inositol, increased malondialdehyde, and damage to DNA and mitochondria; increased nitrosative stress; and decreased ω3 polyunsaturated fatty acids (PUFAs). The complex interplay between the abovementioned IO&NS pathways in depression results in pro-atherogenic effects and should be regarded as a risk factor to future clinical CVD and due mortality. We suggest that major depression should be added as a risk factor to the Charlson "comorbidity" index. It is advised that patients with (sub)chronic or recurrent major depression should routinely be assessed by serology tests to predict if they have an increased risk to cardiovascular disorders.

Increased plasma peroxides and serum oxidized low density lipoprotein antibodies in major depression: markers that further explain the higher incidence of neurodegeneration and coronary artery disease

BACKGROUND

Major depression is characterized by a decreased antioxidant status, an induction of the inflammatory and oxidative and nitrosative (IO&NS) pathways and inflammatory-neurodegenerative (I&ND) pathways. This study examines two markers of oxidative stress in depression, i.e. plasma peroxides and serum oxidized LDL (oxLDL) antibodies.

METHODS

Blood was sampled in 54 patients with major depression (mean+/-SD age=43.5+/-11.6 years) and 37 normal volunteers (43.6+/-11.1 years). The severity of illness was measured by means of the Hamilton Depression Rating Scale. The Fibromyalgia and Chronic Fatigue Syndrome Rating Scale was used to measure severity of "psychosomatic" symptoms in depression.

RESULTS

We found significantly higher plasma peroxides (p=0.002) and serum oxLDL antibodies (p=0.0002) in depressed patients as compared to normal controls. There was no significant correlation between both markers and both independently from each other predicted major depression. There were significant correlations between the oxLDL antibodies and the scores on two items of the FF scale, i.e. gastro-intestinal symptoms and headache.

DISCUSSION

The results show that major depression is accompanied by increased oxidative stress and lipid peroxidation. These results further extend the IO&NS pathophysiology of major depression. Since increased peroxides and oxLDL antibodies are predictors of coronary artery disease (CAD) and neurodegeneration, our findings suggest that IO&NS pathways are involved in the increased incidence of both CAD and neurodegeneration in depression.