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Kumar Nandi N, Das S, Choudhary D, Saini S, Bhatia R, Chawla P, Kaur R, Kalra S, Rawat R, Eyupoglu V, Kumar B. Exploration of oxadiazole clubbed benzhydrylpiperazine pharmacophoric features as structural feature for antidepressant activity: In vitro, in vivo and in silico analysis. Bioorg Chem 2024; 144:107148. [PMID: 38306828 DOI: 10.1016/j.bioorg.2024.107148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/20/2023] [Accepted: 01/22/2024] [Indexed: 02/04/2024]
Abstract
Arylpiperazine clubbed various heterocyclic molecules present potential pharmacophoric structural features for the development of psychoactive drugs. There are various CNS active molecules possessing arylpiperazine moiety in their pharmacophore approved by USFDA. In the current study, we have explored the benzhydrylpiperazine moiety clubbed with various substituted oxadiazole moieties (AP1-12) for their monoamine oxidase (MAO) inhibition and antidepressant potential. Compounds AP3 and AP12 exhibited highly potent and selective MAO-A inhibition with IC50 values of 1.34 ± 0.93 µM and 1.13 ± 0.54 µM, respectively, and a selectivity index of 10- and 13-folds, respectively. Both the compounds displayed reversible binding character at the active site of MAO-A. In further in vivo evaluation, both the compounds AP3 and AP12 displayed potential antidepressant-like character in FST and TST studies via significantly reduced immobility time in comparison to non-treated animals. These compounds displayed no cytotoxicity in SH-SY5Y cell lines, which indicates that these compounds are safe for further evaluation. In silico studies reveal that synthesized compounds possess drug-likeness with minimal to no toxicity. In silico studies were conducted to understand the binding interactions and stability of compounds at the binding pocket of enzyme and observed that both the best compounds fit well at the active site of MAO-A lined by amino acid residues Tyr69, Asn181, Phe208, Ile335, Leu337, Phe352, and Tyr444 similar to standard MAO-A inhibitor clorgiline. The molecular dynamic studies demonstrated that AP3 and AP12 formed quite a stable complex at the active site of MAO-A and did not break under small abruption forces. The favourable binding interactions and appropriate ADMET properties present the benzhydrylpiperazine clubbed oxadiazole pharmacophoric features as a potential structural skeleton for further clinical evaluation and development of a new antidepressant drug molecule.
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Affiliation(s)
- Nilay Kumar Nandi
- Department of Pharmaceutical technology, Meerut institute of engineering and technology, Meerut, Uttar Pradesh 250005, India
| | - Shibam Das
- Department of Pharmaceutical Chemistry and Analysis, ISF College of Pharmacy, Ghal Kalan, Ferozpur G.T. Road, Moga 142001, Punjab, India; Department of Chemistry, University of Turin, Via Pietro Giuria, 7, 10125 Turin, Italy
| | - Diksha Choudhary
- Chitkara College of Pharmacy, Chitkara University, Rajpura 140401, Punjab, India
| | - Suresh Saini
- Center for Nano and Material Science, Jain University (Deemed-to-be University), Jain Global Campus, Jakkasandra Post, Ramanagara 562112, India
| | - Rohit Bhatia
- Department of Pharmaceutical Chemistry and Analysis, ISF College of Pharmacy, Ghal Kalan, Ferozpur G.T. Road, Moga 142001, Punjab, India
| | - Pooja Chawla
- University Institute of Pharmaceutical Sciences and Research, Baba Farid University of Health Sciences, Faridkot, Punjab 151203, India
| | - Rajwinder Kaur
- Chitkara College of Pharmacy, Chitkara University, Rajpura 140401, Punjab, India
| | - Sourav Kalra
- School of Pharmacy, Chitkara University, Baddi, Himachal Pradesh 174103, India
| | - Ravi Rawat
- School of Health Sciences & Technology, UPES University, Dehradun 248007, India.
| | - Volkan Eyupoglu
- Department of Chemistry, Cankırı Karatekin University, Cankırı 18100, Turkey
| | - Bhupinder Kumar
- Department of Pharmaceutical Sciences, HNB Garhwal University, Chauras Campus, Srinagar, Garhwal, Uttarakhand 246174, India; Department of Chemistry, Graphic Era (Deemed to be University), Dehradun 248002, Uttrakhand, India.
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Mufson L, Morrison C, Shea E, Kluisza L, Robbins R, Chen Y, Mellins CA. Screening for depression with the PHQ-9 in young adults affected by HIV. J Affect Disord 2022; 297:276-282. [PMID: 34695500 PMCID: PMC9762407 DOI: 10.1016/j.jad.2021.10.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 10/07/2021] [Accepted: 10/20/2021] [Indexed: 01/17/2023]
Abstract
BACKGROUND Major depressive disorder (MDD) is common among young adults with perinatally acquired HIV (YAPHIV), however it is often underdiagnosed and untreated. The PHQ-9 and PHQ-2 are widely used screening instruments for MDD. This study evaluates the accuracy of recommended PHQ-9 and PHQ-2 cut-scores of 10 and 3 for YAPHIV and YA who were perinatally HIV exposed but uninfected (YAPHEU). METHODS The PHQ-9 was administered to participants (n = 203) in a longitudinal cohort study using the DISC-IV as the gold standard for diagnosing depression. PHQ-9 and PHQ-2 sensitivity and specificity were calculated. ROC curves were constructed for the overall sample and YAPHIV and YAPHEU subsamples. RESULTS Almost all participants were Black and Latinx, ages 18-29. Overall, the recommended PHQ-9 cut-score of ≥10 yielded a sensitivity of 0.47 (95%CI [0.23,0.72]) and specificity of 0.86 (95%CI [0.80, 0.91]). Results indicate that PHQ-9 cut-scores of 7 and PHQ-2 cut-scores of 2 increased sensitivity to 0.76 (95%CI [0.50, 0.93]) and 0.71(95%CI [0.44,0.90]), and decreased specificity to 0.72 (95%CI [0.65, 0.79]) and 0.73 (95%CI [0.66, 0.79]) respectively. Among subsamples, existing PHQ-9 cut-scores were more accurate for MDD diagnoses in YAPHEU (N = 11) than YAPHIV(N = 6). No race/ethnicity or age differences were found. LIMITATIONS Participants were recruited from clinics in NYC and may not reflect all YAPHIV and YAPHEU. Without a white HIV comparison group, no conclusions could be made on the impact of race/ethnicity on optimized PHQ-9 cut-scores. CONCLUSIONS Using tailored cut scores for HIV-affected populations may increase identification of those experiencing or at risk for MDD. Given the need for increased depression screening in HIV care, use of optimized cut-scores could benefit at-risk populations in the US and globally.
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Affiliation(s)
- Laura Mufson
- Division of Child and Adolescent Psychiatry, Columbia University and New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY 10032, USA.
| | - Corey Morrison
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr #15, New York, NY 10032, USA
| | - Eileen Shea
- Department of Psychiatry, Mental Health Data Science, Columbia University Medical Center, 1051 Riverside Dr, New York, NY 10032, USA
| | - Luke Kluisza
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr #15, New York, NY 10032, USA
| | - Reuben Robbins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr #15, New York, NY 10032, USA
| | - Ying Chen
- Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY 10032,New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr #15, New York, NY 10032, USA
| | - Claude A. Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 1051 Riverside Dr #15, New York, NY 10032, USA
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Tully PJ, Higgins R. Depression Screening, Assessment, and Treatment for Patients with Coronary Heart Disease: A Review for Psychologists. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12075] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Phillip J Tully
- Freemasons Foundation Centre for Men's Health, Discipline of Medicine, School of Medicine, The University of Adelaide,
- Department of Medicine, Flinders Medical Centre and Flinders University of South Australia,
| | - Rosemary Higgins
- Heart Research Centre,
- Department of Physiotherapy, The University of Melbourne,
- Cabrini Health,
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Screening for depression in cancer patients using the PHQ-9: The accuracy of somatic compared to non-somatic items. J Affect Disord 2019; 254:74-81. [PMID: 31108283 DOI: 10.1016/j.jad.2019.05.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/25/2019] [Accepted: 05/12/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND The PHQ-9 is a standard screening tool for depressive disorders in cancer patients. As for the frequently reported symptom overlap with somatic disease, it has been debated whether somatic items are suitable for identifying depressive disorders in cancer patients. Thus, this study examines the diagnostic accuracy of somatic versus cognitive-emotional PHQ-9 items. METHODS The routine data of 4,705 patients, screened at the National Center for Tumor Diseases in Heidelberg between 2011 and 2016, was analyzed. For the single PHQ-9 items, receiver operating characteristics (ROC), sensitivity, specificity, positive, and negative predictive values (PPV and NPV), the Youden Index (YI), and the Clinical Utility Index (UI+/UI-) were applied for the diagnoses of major depressive disorder (MDD) and any depressive disorder (ADD). RESULTS The non-somatic items played a pivotal role in the diagnosis of MDD, whereas the diagnostic accuracy of the somatic items increased in the diagnosis of ADD. For both MDD and ADD, the best performance was achieved by the non-somatic items "little interest" and "feeling down." LIMITATIONS In this study, only one self-reported instrument was used (i.e., the PHQ-9). In other words, the diagnoses were not validated by clinical interviews or other self-reported instruments. CONCLUSION The somatic PHQ-9 items showed less discriminatory value than the non-somatic items. However, they may be useful as screening mechanisms for identifying at-risk cancer patients with mild/moderate depression. Disregarding the somatic items would lead to an underestimation of depressive syndromes and inadequate treatment of somatic symptoms.
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Pang T, Gudi A. Chest pain following the use of fluvoxamine in depression. PROCEEDINGS OF SINGAPORE HEALTHCARE 2018. [DOI: 10.1177/2010105818802993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Selective serotonin reuptake inhibitors are considered to be the drug of choice in patients with major depression and cardiovascular disease. Fluvoxamine in particular has been shown to be safe for use in patients with cardiovascular disease. We report a case of chest pain precipitated by fluvoxamine in an elderly lady with a known history of cardiovascular disease. This highlights the need for psychiatrists to be aware of chest pain as a potential side effect of fluvoxamine in their patients.
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Affiliation(s)
- Tamara Pang
- Department of Psychiatry, Singapore General Hospital, Singapore
| | - Alakananda Gudi
- Department of Psychiatry, Singapore General Hospital, Singapore
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Freedland KE, Lemos M, Doyle F, Steinmeyer BC, Csik I, Carney RM. The Techniques for Overcoming Depression Questionnaire: Mokken Scale Analysis, Reliability, and Concurrent Validity in Depressed Cardiac Patients. COGNITIVE THERAPY AND RESEARCH 2017; 41:117-129. [PMID: 28239215 DOI: 10.1007/s10608-016-9797-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The Techniques for Overcoming Depression (TOD) questionnaire assesses the frequency with which patients being treated for depression use cognitive-behavioral techniques in daily life. This study examined its latent structure, reliability and concurrent validity in depressed cardiac patients. METHOD The TOD was administered at the initial and final treatment sessions in three trials of cognitive behavior therapy (CBT) (n = 260) for depression in cardiac patients. Mokken scaling was used to determine its dimensionality. RESULTS The TOD is unidimensional in depressed cardiac patients, both at the initial evaluation (H = .46) and the end of treatment (H = .47). It is sensitive to change and the total score correlates with therapist ratings of the patient's socialization to CBT (r=.40, p<.05), homework adherence (r=0.36, p<0.05), and use of cognitive-behavioral techniques (r=.51, p<.01). TOD scores were associated with post-treatment depression scores in two of the trials (p<.01 in both analyses). CONCLUSIONS The TOD is a unidimensional, reliable, valid, and clinically informative measure of self-reported use of cognitive-behavioral techniques for overcoming depression in cardiac patients. Studies of the TOD in other depressed patient populations are needed.
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Affiliation(s)
- Kenneth E Freedland
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri USA
| | | | - Frank Doyle
- Division of Population Health Sciences (Psychology), Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Brian C Steinmeyer
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri USA
| | - Iris Csik
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri USA
| | - Robert M Carney
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri USA
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Dobbels F, De Geest S, Vanhees L, Schepens K, Fagard R, Vanhaecke J. Depression and the Heart: A Systematic Overview of Definition, Measurement, Consequences and Treatment of Depression in Cardiovascular Disease. Eur J Cardiovasc Nurs 2016; 1:45-55. [PMID: 14622867 DOI: 10.1016/s1474-5151(01)00012-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Depression is an independent risk factor in the pathogenesis of cardiovascular disease and it is a prevalent disorder after cardiovascular disease associated with negative outcome in terms of mortality and morbidity. It is a dangerous condition requiring adequate screening and treatment, however, it often remains undiagnosed and thus untreated. Non-psychiatric healthcare workers, like nurses, general practitioners, physiotherapists and cardiologists are the health providers most closely involved in the management of patients with cardiovascular disease. They can play an important role in screening cardiovascular patients for depressive symptoms and in referring them for treatment. The purpose of this article therefore is to provide an evidence-based framework, aiming to educate non-psychiatric healthcare providers on depressive disorder in the context of chronic cardiovascular disease. In this paper, an overview of the definition, prevalence and consequences of depression will be discussed. Moreover, an overview of measurement methods and treatment modalities for depression will be provided. In addition, a step-by-step guide is provided in order to help non-psychiatric healthcare providers in dealing with depressed patients.
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Affiliation(s)
- Fabienne Dobbels
- Department of Cardiology, Cardiovascular Rehabilitation Unit, University Hospital of Leuven, Leuven, Belgium.
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Oflaz S, Yüksel Ş, Şen F, Özdemiroğlu F, Kurt R, Oflaz H, Kaşikcioğlu E. Does Illness Perception Predict Posttraumatic Stress Disorder in Patients with Myocardial Infarction? Noro Psikiyatr Ars 2014; 51:103-109. [PMID: 28360608 DOI: 10.4274/npa.y6394] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2011] [Accepted: 09/12/2012] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Myocardial infarction (MI) as a life-threatening event, carrying high risk of recurrence and chronic disabling complications, increases the risk of developing acute stress disorder (ASD), posttraumatic stress disorder (PTSD), or both. The aim of this study was to investigate the relationship between illness perceptions and having ASD, PTSD, or both in patients after MI. METHOD Seventy-six patients diagnosed with acute MI were enrolled into our prospective study. We evaluated patients during the first week and six months after MI. Patients were assessed by using the Clinician Administered PTSD Scale (CAPS), the Hamilton Depression Rating Scale (HDRS), the Hamilton Anxiety Rating Scale (HARS), the Brief Illness Perception Questionnaire (BIPQ), and a semi-structured interview for socio-demographic characteristics during both the first and second evaluations. RESULTS Acute stress disorder (ASD) developed in 9.2% of patients and PTSD developed in 11.9% of patients with MI. Illness perception factors of 'consequences, identity and concern' predicted the occurrence of both ASD and PTSD, whereas 'emotion' predicted only PTSD. CONCLUSION The factors of illness perceptions predicted the induction of ASD and PTSD in patients who had acute MI.
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Affiliation(s)
- Serap Oflaz
- İstanbul University Faculty of Medicine, Department of Psychiatry, İstanbul, Turkey
| | - Şahika Yüksel
- İstanbul University Faculty of Medicine, Department of Psychiatry, İstanbul, Turkey
| | - Fatma Şen
- İstanbul University Faculty of Medicine, Department of Internal Medicine, İstanbul, Turkey
| | | | - Ramazan Kurt
- Marmara University Faculty of Medicine, Department of Internal Medicine, İstanbul, Turkey
| | - Hüseyin Oflaz
- İstanbul University Faculty of Medicine, Department of Cardiology, İstanbul, Turkey
| | - Erdem Kaşikcioğlu
- İstanbul University Faculty of Medicine, Department of Sports Medicine, İstanbul, Turkey
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Versteeg H, Hoogwegt MT, Hansen TB, Pedersen SS, Zwisler AD, Thygesen LC. Depression, not anxiety, is independently associated with 5-year hospitalizations and mortality in patients with ischemic heart disease. J Psychosom Res 2013; 75:518-25. [PMID: 24290040 DOI: 10.1016/j.jpsychores.2013.10.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 09/12/2013] [Accepted: 10/07/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The objective of the current study was to examine whether depression and anxiety are independently associated with 5-year cardiac-related hospitalizations and all-cause mortality in patients with ischemic heart disease (IHD). METHODS Patients treated for MI, angina, or ischemic heart failure (N=610) were recruited from Holbæk Hospital, Denmark. All patients completed the Hospital Anxiety and Depression Scale (HADS) in December 2005. Data regarding patient characteristics at baseline, and hospitalizations and deaths during follow-up were collected from Danish population-based registers. Cox and negative binomial regression analyses were performed to examine the relationship between depression, anxiety and the endpoints. RESULTS At baseline, 71 (11.6%) patients reported depression and 120 (19.7%) reported anxiety. Models including both depression and anxiety showed that depression was independently associated with time to first cardiac-related hospitalization, cumulative number and length of cardiac-related hospitalizations, and all-cause mortality, while anxiety was only associated with the total length of hospitalizations (all p-values <.05). After adding sociodemographic and clinical factors, depression remained associated with the number (incidence rate ratio (IRR)=2.00, 95% confidence interval (CI): 1.44-2.77) and length of cardiac-related hospitalizations (IRR=3.69, 95% CI: 2.75-4.96), and all-cause mortality (hazard ratio (HR)=2.12, 95% CI: 1.13-3.96). The associations between depression and time to first hospitalization and between anxiety and length of stay were eliminated. CONCLUSIONS The current study showed that depression, and not anxiety, is associated with the number and length of cardiac-related hospitalizations and all-cause mortality in IHD patients, independent of traditional risk factors. In order to improve health outcomes, better awareness and treatment of depression in IHD patients are crucial.
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Affiliation(s)
- Henneke Versteeg
- Center of Research on Psychology in Somatic diseases (CoRPS), Tilburg University, The Netherlands.
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Valiengo LCL, Benseñor IM, Lotufo PA, Fraguas R, Brunoni AR. Transcranial direct current stimulation and repetitive transcranial magnetic stimulation in consultation-liaison psychiatry. Braz J Med Biol Res 2013; 46:815-23. [PMID: 24141608 PMCID: PMC3854309 DOI: 10.1590/1414-431x20133115] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Accepted: 07/15/2013] [Indexed: 11/22/2022] Open
Abstract
Patients with clinical diseases often present psychiatric conditions whose
pharmacological treatment is hampered due to hazardous interactions with the
clinical treatment and/or disease. This is particularly relevant for major
depressive disorder, the most common psychiatric disorder in the general
hospital. In this context, nonpharmacological interventions could be useful
therapies; and, among those, noninvasive brain stimulation (NIBS) might be an
interesting option. The main methods of NIBS are repetitive transcranial
magnetic stimulation (rTMS), which was recently approved as a nonresearch
treatment for some psychiatric conditions, and transcranial direct current
stimulation (tDCS), a technique that is currently limited to research scenarios
but has shown promising results. Therefore, our aim was to review the main
medical conditions associated with high depression rates, the main obstacles for
depression treatment, and whether these therapies could be a useful intervention
for such conditions. We found that depression is an important and prevalent
comorbidity in a variety of diseases such as epilepsy, stroke, Parkinson's
disease, myocardial infarction, cancer, and in other conditions such as
pregnancy and in patients without enteral access. We found that treatment of
depression is often suboptimal within the above contexts and that rTMS and tDCS
therapies have been insufficiently appraised. We discuss whether rTMS and tDCS
could have a significant impact in treating depression that develops within a
clinical context, considering its unique characteristics such as the absence of
pharmacological interactions, the use of a nonenteral route, and as an
augmentation therapy for antidepressants.
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Affiliation(s)
- L C L Valiengo
- Centro de Pesquisas Clínicas, Hospital Universitário, Universidade de São Paulo, São PauloSP, Brasil
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Freedland KE, Carney RM. Depression as a risk factor for adverse outcomes in coronary heart disease. BMC Med 2013; 11:131. [PMID: 23675637 PMCID: PMC3658994 DOI: 10.1186/1741-7015-11-131] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2012] [Accepted: 05/01/2013] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Depression is firmly established as an independent predictor of mortality and cardiac morbidity in patients with coronary heart disease (CHD). However, it has been difficult to determine whether it is a causal risk factor, and whether treatment of depression can improve cardiac outcomes. In addition, research on biobehavioral mechanisms has not yet produced a definitive causal model of the relationship between depression and cardiac outcomes. DISCUSSION Key challenges in this line of research concern the measurement of depression, the definition and relevance of certain subtypes of depression, the temporal relationship between depression and CHD, underlying biobehavioral mechanisms, and depression treatment efficacy. SUMMARY This article examines some of the methodological challenges that will have to be overcome in order to determine whether depression should be regarded as a key target of secondary prevention in CHD.
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Affiliation(s)
- Kenneth E Freedland
- Department of Psychiatry, Washington University School of Medicine, 4320 Forest Park Avenue, St Louis, MO 63108, USA.
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Diagnosis of posttraumatic stress disorder after surgery for primary rhegmatogenous retinal detachment. Retina 2013; 33:111-9. [PMID: 22772393 DOI: 10.1097/iae.0b013e31825d7ea4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSES To investigate the prevalence of posttraumatic stress disorder (PTSD) in patients who underwent surgery for primary rhegmatogenous retinal detachment and to explore variables associated with the disorder. METHODS Subjects eligible for the study were patients aged 18 years or older, who underwent surgery for primary rhegmatogenous retinal detachment at the Goldschleger Eye Institute, from January 1, 2004, to December 31, 2009, and were followed for at least 1 month. Study patients were screened for the existence of PTSD symptoms via a telephone survey, and positively identified patients were asked to undergo a structured psychiatric interview. Posttraumatic stress disorder was assessed by the Clinician Administered PTSD Scale, and the 25-item National Eye Institute visual function questionnaire (NEI-VFQ-25) was used as a measure of vision-related quality of life. Objective clinical measures were obtained from the patient's medical records. Clinical variables were compared between PTSD-diagnosed patients, patients who were screened for PTSD but were found to be PTSD negative in the interview (false-positive group), and patients who were found negative for PTSD in the screening survey. RESULTS Of the 547 eligible patients, 366 were enrolled in the study. Nine patients (2.5%) met the criteria for PTSD diagnosis. Posttraumatic stress disorder patients reported significantly more traumatic events in their past (P = 0.015), and for these patients, NEI-VFQ-25 composite score was significantly lower (P < 0.001). Clinical measures were not found as independent risk factors for PTSD prediction. CONCLUSION Posttraumatic stress disorder may develop in the aftermath of primary rhegmatogenous retinal detachment. Previous traumatic events and NEI-VFQ-25 scores were found as independent risk factors for PTSD prediction.
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Lisspers J, Nygren Å, Söderman E, Candidate D. Psychological Patterns in Patients with Coronary Heart Disease, Chronic Pain and Respiratory Disorder. Scand J Caring Sci 2013. [DOI: 10.1111/j.1471-6712.1998.tb00471.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Are somatic symptoms of depression better predictors of cardiac events than cognitive symptoms in coronary heart disease? Psychosom Med 2012; 74:33-8. [PMID: 22219384 PMCID: PMC3254789 DOI: 10.1097/psy.0b013e3182405ac4] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Several recent studies have found that somatic symptoms of depression predict cardiac events in patients with established coronary heart disease but cognitive symptoms of depression do not. However, other studies have not supported this finding, and the research in this area is complicated by methodological differences and inconsistencies in the classification of "cognitive" and "somatic" symptoms. In addition, somatic symptoms are more common than cognitive symptoms in cardiac patients and are often associated with more severe depression. These factors may confound the relationship between somatic symptoms and cardiac outcomes. Some reasons why somatic symptoms may be more common than cognitive symptoms in cardiac patients are considered, as well as whether somatic symptoms are likely to be symptoms of depression or of medical illness. Finally, some directions for future research are proposed.
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Bunevicius A, Brozaitiene J, Stankus A, Bunevicius R. Specific fatigue-related items in self-rating depression scales do not bias an association between depression and fatigue in patients with coronary artery disease. Gen Hosp Psychiatry 2011; 33:527-9. [PMID: 21851985 DOI: 10.1016/j.genhosppsych.2011.06.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2011] [Revised: 06/24/2011] [Accepted: 06/27/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Self-rating instruments for depression include questions targeting fatigue, which is a common symptom of coronary artery disease (CAD) patients. We evaluated if specific fatigue-related questions in self-reported instruments of depression bias an association between fatigue and depression in CAD patients. METHODS A total of 1470 CAD patients attending cardiac rehabilitation program were evaluated for fatigue using the Multidimensional Fatigue Inventory (MFI-20) and for symptoms of depression using the depression subscale of the Hospital Anxiety and Depression scale (HADS-D) and the Beck Depression Inventory-II (BDI-II). RESULTS There was moderate correlation in MFI-20 scores vs. HADS-D scores and in MFI-20 scores vs. BDI-II scores, with stronger association in patients with less severe heart failure when compared to patients with more severe heart failure. Removal of questions targeting fatigue from the HADS-D and the BDI-II did not significantly change the association. CONCLUSIONS Fatigue-related items should not be removed from the HADS-D and the BDI-II when evaluating CAD patients for depressive symptoms.
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Affiliation(s)
- Adomas Bunevicius
- Institute of Psychophysiology and Rehabilitation, Lithuanian University of Health Sciences, Palanga, Lithuania.
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Ketterer MW, Knysz W, Khandelwal A, Keteyian SJ, Farha A, Deveshwar S. Healthcare Utilization and Emotional Distress in Coronary Artery Disease Patients. PSYCHOSOMATICS 2010. [DOI: 10.1016/s0033-3182(10)70700-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Summers KM, Martin KE, Watson K. Impact and clinical management of depression in patients with coronary artery disease. Pharmacotherapy 2010; 30:304-22. [PMID: 20180613 DOI: 10.1592/phco.30.3.304] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The rates of major adverse coronary events, including recurrent ischemic events and death, in patients with coronary artery disease (CAD) have been shown to be significantly increased in patients with depression. In addition, health care costs are higher and health-related quality of life is lower in depressed patients with CAD. Several pathophysiologic mechanisms have been proposed for the association of increased events seen in this population. Studies have focused on antidepressants (specifically, selective serotonin reuptake inhibitors and mirtazapine), psychotherapy (cognitive behavioral therapy and interpersonal psychotherapy), and a wide range of other nonpharmacologic interventions. Pharmacologic and nonpharmacologic treatments are known to improve depressive symptoms in patients with CAD, but their effects on outcomes such as mortality and hospital admissions remain controversial. If treatment of depression is warranted, strategies should include sertraline or citalopram, with or without cognitive behavioral therapy, based on the known efficacy and safety of the drugs in this population. Nonpharmacologic therapy such as aerobic exercise has been shown to improve not only depression but also cardiovascular health. When selecting an appropriate antidepressant, clinicians should consider their patients' comorbid conditions and the potential for drug interactions, and treatment should be frequently monitored. Screening for depression in patients with cardiac disease should be instituted on a routine basis by using either case-finding or symptom-triggered approaches. Based on the high prevalence of depression and its known adverse effects in patients with CAD, future research is needed to help determine the role of antidepressants and nonpharmacologic strategies in improving outcomes in patients with both comorbidities.
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Affiliation(s)
- Kelly M Summers
- Department of Pharmacy Practice and Science, School of Pharmacy, University of Maryland, Baltimore, Maryland 21201, USA.
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Abstract
Major depression is a common comorbid condition in patients with coronary heart disease (CHD). Although mild emotional distress may be a normal reaction to myocardial infarction or other manifestations of CHD, major depression should not be considered a normal reaction, nor should it be ignored. Major depression is a debilitating comorbid disorder that can seriously complicate recovery and increase the risks of further cardiac morbidity and mortality. Fortunately, it is one that can be successfully treated in the majority of cases. The purpose of this review is to present the evidence for the negative prognostic effects of depression in cardiac patients and to discuss methods for assessing and treating depression in these patients.
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Affiliation(s)
- R M Carney
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63178, USA
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Ketterer MW, Knysz W, Keteyian S, Schairer J, Jafri S, Alam M, Farha A, Deveshwar S. Cardiovascular Symptoms in Coronary-Artery Disease Patients Are Strongly Correlated With Emotional Distress. PSYCHOSOMATICS 2008; 49:230-4. [DOI: 10.1176/appi.psy.49.3.230] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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20
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Psychiatric disorders in hypertrophic cardiomyopathy. Gen Hosp Psychiatry 2008; 30:49-54. [PMID: 18164940 DOI: 10.1016/j.genhosppsych.2007.09.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2007] [Revised: 09/26/2007] [Accepted: 09/26/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Depression is undertreated in cardiac disease. Our aim was to evaluate frequency and risk factors of psychiatric disorders in hypertrophic cardiomyopathy. METHODS This was a two-phase epidemiological approach, using screening questionnaire then gold standard structured clinical interview. A cohort of 148 patients aged > or =18 (78% response rate) attending a dedicated hypertrophic cardiomyopathy clinic (1996-1998) were screened for psychiatric morbidity using Hospital Anxiety and Depression Scale and Social Adjustment Scale. Likely cases and noncases were evaluated by Structured Clinical Interview for DSM-III-R. The main outcome measure was prevalence of psychiatric diagnoses, with descriptive comparison against population statistics. RESULTS Thirty-seven percent of cardiomyopathy patients fulfilled criteria for anxiety disorder and 21% for mood disorder. Presence of mood disorder was associated with chest pain [relative risk (RR) 4.5, 95% CI 2.8-17.5], older age (2.8, 1.4-5.6), higher perceived risk of death (5.4, 2.3-13.0), poorer social adjustment (2.1, 1.1-4.2) and problems with sexual relations (1.5, 1.2-3.6). Presence of anxiety disorders was associated with chest pain (RR 3.5, 95% CI 2.1-26.0), higher perceived risk of death (2.0, 1.2-3.4), perception of physical symptoms as 'severe' (2.2, 1.2-4.2) and more recent diagnosis (1.7, 1.0-2.7). CONCLUSIONS Patients with cardiomyopathy have an elevated risk of mood disorders and anxiety disorders. Several demographic and clinical factors were found to be associated with these psychiatric conditions. Proper treatment intervention is likely to improve quality of life.
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Abstract
The objective of the study was to compare the frequency of mental disorders in cardiology outpatients to the number of patients with psychological problems identified by cardiologists. In a cardiology outpatient service, 103 consecutive patients were asked to participate in the study. Of these 86 were included and screened for mental disorder with the Primary Care Evaluation of Mental Disorders (PRIME-MD), Structured Clinical Interview for DSM-IV (SCID) psychosis screening, the Clock Drawing Test, and the WHO-5 Well-being Index. The cardiologists were asked to rate the severity of somatic and mental problems in each patient on visual analogue scales (VAS-som and VAS-men). The current treatments, including psychiatric and psychological treatments, were noted, and the survival was followed for 3 years. Of the 86 patients included, 34 (40%) had a diagnosis of mental disorder. Eleven (12.8%) had major depression, six (7.0%) minor depression, six (7.0%) anxiety disorder, two unspecified somatoform disorder, seven (8.1%) dementia, one alcohol abuse and one psychosis. Three of the patients were in long-term psychopharmacological treatment. Although the cardiologists predicted mental disorder significantly better than chance, none of the patients was in relevant treatment for their mental disorder. At 3-year follow-up, 20 (24%) of the patients had died. Age and severity of heart disease predicted mortality, while the presence of a mental disorder did not. Mental disorders, especially depression, were frequent in cardiology outpatients. Even in cases where the cardiologists identified psychological problems, the diagnosis had no consequence, as none of the patients was offered relevant treatment.
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Affiliation(s)
- Morten Birket-Smith
- Liaison Psychiatry Unit, Bispebjerg University Hospital, Copenhagen, Denmark.
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Hardin SR. Cardiac Disease and Sexuality: Implications for Research and Practice. Nurs Clin North Am 2007; 42:593-603; vii. [DOI: 10.1016/j.cnur.2007.07.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Ketterer MW, Knysz W. Screening, diagnosis & monitoring of depression/distress in CHF patients. Heart Fail Rev 2007; 14:1-5. [PMID: 17668320 DOI: 10.1007/s10741-007-9046-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2007] [Accepted: 06/19/2007] [Indexed: 10/23/2022]
Abstract
Objective and validated measures of depression/distress (anxiety and anger) are available and readily usable at the bedside or in clinic. Foremost among these is the Patient's Health Questionnaire--an adaptation of DSM IV criteria for Major Depressive Disorder that permits administration and scoring by nursing or physician personnel, and quantification of the intensity of depression. A score of 10 or greater indicates a need for evaluation/treatment. Because of patient denial/minimization/alexithymia, PHQ negatives should undergo further screening by having a spouse or friend complete a depression/distress rating scale. The only standardized, normed, and validated spouse/friend scale presently available is the Ketterer Stress Symptom Frequency Checklist, which is available by internet.
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Affiliation(s)
- Mark W Ketterer
- Henry Ford Hospital/CFP6, 2799 West Grand Boulevard, Detroit, MI 48202, USA.
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Ketterer MW, Brawner CA, Van Zant M, Keteyian SJ, Ehrman JK, Knysz W, Farha A, Deveshwar S, Wulsin L. Empirically Derived Psychometric Screening for Emotional Distress in Coronary Artery Disease Patients. J Cardiovasc Nurs 2007; 22:320-5. [PMID: 17589285 DOI: 10.1097/01.jcn.0000278954.44759.3a] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND RESEARCH OBJECTIVES Multiple types of evidence implicate emotional distress as a cause of adverse outcomes in individuals with coronary artery disease. The present study was intended to determine the most accurate and user-friendly means of screening patients with coronary artery disease for emotional distress using age at initial diagnosis as the criterion. SUBJECTS AND METHODS Two clinical databases consisting of patients with documented coronary artery disease, each contained multiple measures of emotional distress, were used. These databases were investigated by tests of covariation of the emotional distress measures with age at initial diagnosis. If these were statistically significant, sequential testing of cutpoints yielded the minimum score for positivity. Sensitivity, specificity, and positive predictive value calculations were made for the significant measures. Single-sex tests of covariation were also examined. RESULTS AND CONCLUSIONS The Patient Health Questionnaire was the only significant bedside measure of emotional distress (Pearson r = -0.149, P = .058), with a cutpoint of 10 or greater. The Beck Depression Inventory, Hospital Anxiety and Depression Scale, and Crown-Crisp Phobic Anxiety Scale failed to reach significance as covariates of age at initial diagnosis. Substantially greater sensitivity occurs with larger and more cumbersome measures of emotional distress. For example, the Ketterer Stress Symptom Frequency Checklist yielded consistent results with greater variance explained, particularly in men (Pearson r for self-ratings of anger = -0.339, P = .001; depression = -0.363, P = .005; anxiety = -0.273, P = .028). Brief bedside/clinic screening of emotional in populations with coronary artery disease is possible and necessary to improve quality of life, compliance (eg, smoking cessation), and possibly morbidity/mortality. Initial screening can and should occur at the bedside/clinic by cardiology or primary care personnel using the Patient Health Questionnaire.
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Affiliation(s)
- Mark W Ketterer
- Heart & Vascular Institute, and Consultation/Liaison Psychiatry, Henry Ford Hospital, Wayne State University, Detroit, MI 48202, USA.
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Ahmed A, Lefante CM, Alam N. Depression and nursing home admission among hospitalized older adults with coronary artery disease: a propensity score analysis. ACTA ACUST UNITED AC 2007; 16:76-83. [PMID: 17380615 PMCID: PMC2914576 DOI: 10.1111/j.1076-7460.2007.05519.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Admission to a nursing home is considered a poor outcome for community-dwelling older adults. The objective of this study was to determine whether depression increased the risk of nursing home admission. Using the National Hospital Discharge Survey 2001-2003 datasets, the authors identified 28,172 community-dwelling older adults, 65 years and older, discharged alive with a primary discharge diagnosis of coronary artery disease. The objective of this study was to determine the association between depression and subsequent nursing home admissions in these patients. Propensity scores for depression, calculated for each patient using a multivariable logistic regression model, were used to match 686 depressed patients with 2058 nondepressed patients who had similar propensity scores. Logistic regression analyses were used to determine the association between depression and nursing home admission. Patients had a mean age +/- SD of 77+/-8 years, and 61% were women. Compared with 9% of nondepressed patients, 13% of depressed patients were admitted to nursing homes (relative risk, 1.42; 95% confidence interval, 1.12-1.78). When adjusted for various demographic, clinical, and care-related covariates, the association became somewhat stronger (adjusted relative risk, 1.55; 95% confidence interval, 1.21-1.99). In ambulatory older adults hospitalized with coronary artery disease, a secondary diagnosis of depression was associated with a significantly increased risk of nursing home admission.
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Affiliation(s)
- Ali Ahmed
- Division of Gerontology and Geriatric Medicine, Department of Medicine, School of Medicine, University of Alabama at Birmingham, AL, USA.
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Fusar-Poli P, Picchioni M, Martinelli V, Bhattacharyya S, Cortesi M, Barale F, Politi P. Anti-depressive Therapies After Heart Transplantation. J Heart Lung Transplant 2006; 25:785-93. [PMID: 16818121 DOI: 10.1016/j.healun.2006.03.019] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2005] [Revised: 02/07/2006] [Accepted: 03/27/2006] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Despite an improved quality of life, about 33% of heart transplant recipients will develop depressive symptoms post-operatively. To date, no review has explored the efficacy and safety of pharmacologic or psychologic interventions in this patient group. METHODS We conducted a comprehensive Medline, EmBase, Psycinfo search for studies of the treatment of depression in heart transplant recipients. RESULTS We identified 34 studies of variable methodologic quality. Selective serotonin re-uptake inhibitors (SSRIs), particularly citalopram and new-generation anti-depressants (mirtazapine), seem to represent the best therapeutic choices for this population. Tricyclic anti-depressants (TCAs), and electroconvulsive therapy (ECT) should be reserved for severe depression unresponsive to other treatments, whereas monoamine oxidase inhibitors (MAOIs) should be avoided. St John's wort, an alternative herbal drug, has been associated with life-threatening immunosuppression. Psychologic therapy offers further advantages after heart transplantation. CONCLUSIONS Further well-conducted, randomized, controlled trials are needed to clarify the efficacy and the safety of pharmacologic (SSRIs and atypical anti-depressants) and psychologic interventions in the management of depression after heart transplantation.
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Affiliation(s)
- Paolo Fusar-Poli
- Department of Applied and Psychobehavioural Sciences, University of Pavia, Pavia, Italy.
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Di Benedetto M, Lindner H, Hare DL, Kent S. Depression following acute coronary syndromes: a comparison between the Cardiac Depression Scale and the Beck Depression Inventory II. J Psychosom Res 2006; 60:13-20. [PMID: 16380305 DOI: 10.1016/j.jpsychores.2005.06.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVE This study compared the Cardiac Depression Scale (CDS) and the Beck Depression Inventory II (BDI-II). METHOD Depression was assessed in 81 participants, 2 weeks post-ACS, using the BDI-II and the Composite International Diagnostic Interview. RESULTS The CDS had a strong concurrent validity with the BDI-II (r=.69). Cross-validation of the BDI-II and the CDS with the structured interview demonstrated the ability of both measures to detect severe symptoms. More patients were classified as depressed using the CDS. The CDS also had a significantly higher correlation with a trait anxiety measure than the BDI-II did. CONCLUSION The CDS is a more suitable scale for assessing the less severe depressive symptoms typically seen in a cardiac population.
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Fusar-Poli P, Martinelli V, Klersy C, Campana C, Callegari A, Barale F, Viganò M, Politi P. Depression and quality of life in patients living 10 to 18 years beyond heart transplantation. J Heart Lung Transplant 2005; 24:2269-78. [PMID: 16364881 DOI: 10.1016/j.healun.2005.06.022] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2005] [Revised: 06/21/2005] [Accepted: 06/24/2005] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The purpose of this study was to advance current understanding of factors that influence long-term quality-of-life (QoL) outcomes after heart transplantation, by addressing the influence of depression on perceived health status. METHODS Data were collected from all recipients (n = 137) still alive at >10 years after transplantation. They completed the Short Form Health Survey (SF-36) inventory and the Beck Depression Inventory (BDI) questionnaire, while objective measures of health status were retrieved from medical records. All instruments used had acceptable reliability and validity. Data were analyzed using descriptive statistics, general linear regression models and survival analysis. RESULTS We assessed 137 patients who received transplants between November 1985 and June 1994 in Pavia and have survived 10 to 18 years after transplantation (mean 13.64 years, SD 2.25). They rated their health as good and only the physical QoL (PCS) was impaired when compared with the general population. Thirty-two percent of patients experienced mood depressive symptoms in the long term after transplantation, indicating a low perceived QoL. Higher educational qualification (p = 0.049), being unemployed and receiving a disability pension (p = 0.001), high triglycerides levels (p = 0.020) and lack of physical activity (p < 0.001) were predictors of high BDI scores. CONCLUSIONS Assessment of depression levels and better understanding of risk factors for psychiatric disorders in the long term after transplantation could be of benefit in predicting negative outcomes and allowing future developments in patient management.
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Affiliation(s)
- Paolo Fusar-Poli
- DSSAeP, Sezione di Psichiatria, Università di Pavia and Servizio Psichiatrico di Diagnosi e Cura San Matteo, Pavia, Italy.
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van Melle JP, de Jonge P, Kuyper AMG, Honig A, Schene AH, Crijns HJGM, van den Berg MP, van Veldhuisen DJ, Ormel J. Prediction of depressive disorder following myocardial infarction data from the Myocardial INfarction and Depression-Intervention Trial (MIND-IT). Int J Cardiol 2005; 109:88-94. [PMID: 16002163 DOI: 10.1016/j.ijcard.2005.05.053] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2005] [Revised: 05/24/2005] [Accepted: 05/28/2005] [Indexed: 01/19/2023]
Abstract
BACKGROUND Depression following myocardial infarction (MI) is associated with complicated cardiac rehabilitation, non-compliance and poor prognosis. Whether depression following MI can be predicted from variables routinely assessed during hospitalization for MI is unknown. METHODS Using data from the Myocardial INfarction and Depression-Intervention Trial (MIND-IT), we identified 2,177 MI patients (mean age 63 years; 23% female). Patients were randomly divided into a derivation and a validation sample. In the derivation sample, we analyzed variables potentially associated with the development of post-MI depressive disorder, which were tested in the validation sample. RESULTS In the year following MI, 18.5% suffered from depressive disorder (ICD-10 criteria). In a multivariate model, factors associated with depression were younger age (OR 1.94; CI 1.38-2.74), hypercholesterolemia (OR 1.68; CI 1.08-2.61), the use of calcium channel blockers at discharge (OR 1.80; CI 1.20-2.71), and left ventricular ejection fraction (LVEF) (OR 4.14 for patients with LVEF <30%; CI (2.42-7.10). The derived predictors were tested in the validation sample. The final model yielded two clinical predictors, i.e., younger age and severe LV-dysfunction, which correctly predicted post-discharge depression status in 82.9% of the MI patients. The model yielded a high negative predictive value (89%). A positive depression questionnaire (BDI) during hospitalization increased the positive predictive value of 23% to 52%. CONCLUSIONS During hospitalization for MI and using a two-step strategy with common clinical variables, i.e., younger age, severe LV-dysfunction and BDI score during hospitalization, it is possible to identify MI patients with a high risk for subsequent development of depression.
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Affiliation(s)
- Joost P van Melle
- Department of Cardiology, Thorax Centre, University Medical Centre Groningen, P.O. Box 30.001, 9700 RB, The Netherlands.
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Spijkerman TA, van den Brink RHS, Jansen JHC, Crijns HJGM, Ormel J. Who is at risk of post-MI depressive symptoms? J Psychosom Res 2005; 58:425-32; discussion 433-4. [PMID: 16026657 DOI: 10.1016/j.jpsychores.2005.02.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of this study was to identify cardiologic, psychologic, and demographic risk factors in two groups of patients with post-myocardial infarction (MI) depressive symptoms (in-hospital and during the postdischarge year). METHODS Patients admitted for MI were assessed for depressive symptoms with the Beck Depression Inventory (BDI) during hospitalization and 3, 6, and 12 months post-MI. We contrasted both groups with nondepressed patients. RESULTS Pre-MI vital exhaustion, living alone, history of depressive disorder, history of MI, poor performance on exercise tolerance testing, and female gender were significantly and independently associated with in-hospital depressive symptoms. Pre-MI vital exhaustion, history of depressive disorder, female gender, poor ejection fraction, and longer hospital stay were independent predictors of the development of postdischarge depressive symptoms. CONCLUSIONS Post-MI depressive symptoms seem largely driven by the psychological and social consequences of the MI in patients vulnerable to depression, as indexed by a history of depression and vital exhaustion.
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Affiliation(s)
- Titia A Spijkerman
- Department of Psychiatry, University Hospital Groningen, Graduate School of Behavioral and Cognitive Neurosciences, University of Groningen, The Netherlands.
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Bjerkeset O, Nordahl HM, Mykletun A, Holmen J, Dahl AA. Anxiety and depression following myocardial infarction: gender differences in a 5-year prospective study. J Psychosom Res 2005; 58:153-61. [PMID: 15820843 DOI: 10.1016/j.jpsychores.2004.07.011] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2003] [Accepted: 07/19/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of this study was to examine the impact of the first myocardial infarction (MI) and the relative influence of preexisting confounding factors on anxiety and depression in the following 5 years. METHODS A total of 23,693 participants, 35-79 years of age at baseline, attended two population-based prospective studies in 1984-1986 and in 1995-1997. They underwent physical examination and self-reported demographic, lifestyle, psychosocial, and medical health characteristics in both surveys. Outcome measure was the Hospital Anxiety and Depression rating Scale (HADS). RESULTS Five hundred twelve participants suffered their first MI in the last 5 years before follow-up. Women showed an increased risk for both anxiety and depression in the first 2 years post-MI, followed by a significant symptom reduction. In contrast, the risk for depression in men increased after 2 years post-MI. Anxiety and depression, low educational level, obesity, daily smoking, and physical inactivity pre-MI significantly predicted a poor psychiatric outcome at follow-up. CONCLUSION Five-year follow-up after MI revealed gender-specific outcomes of anxiety and depression not previously described.
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Affiliation(s)
- Ottar Bjerkeset
- HUNT Research Centre, Norwegian University of Science and Technology, Trondheim, Norway.
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Sørensen C, Brandes A, Hendricks O, Thrane J, Friis-Hasche E, Haghfelt T, Bech P. Psychosocial predictors of depression in patients with acute coronary syndrome. Acta Psychiatr Scand 2005; 111:116-24. [PMID: 15667430 DOI: 10.1111/j.1600-0447.2004.00430.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To describe the prevalence of depression according to ICD-10 criteria using a self-completed questionnaire and to identify psychosocial predictors of depression at discharge in patients with acute coronary syndrome. METHOD A total of 899 patients with acute coronary syndrome completed the Major Depression Inventory at discharge and a questionnaire regarding previous depression and family history of depression. Information concerning civil status was obtained from the Civil Person Registry. RESULTS Ninety patients (10%) were depressed according to ICD-10 criteria at discharge with 7.2% having a moderate to severe depression at discharge. Women were significantly more frequently and severely depressed than men. Patients with and without depression reported primarily somatic symptoms of depression. Cardiovascular risk factors or treatment did not differ between patients with and without depression. Previous depression (OR 2.9, 95% CI 1.4-6.0 adjusted) and female gender (OR 2.5, 95% CI 1.5-4.3 adjusted) predicted depression at discharge in a logistic regression model. CONCLUSION Somatic symptoms of depression are prevalent in patients with acute coronary syndrome. The use of self-completed non-diagnostic questionnaires assessing symptoms of depression therefore is cautioned as patients may wrongly be identified as depressed. In patients with acute coronary syndrome depression is predicted by well-known psychosocial risk factors.
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Affiliation(s)
- C Sørensen
- The Medical Reseach Unit, Ringkøbing County, Ringkøbing, Denmark.
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Doerfler LA, Paraskos JA. Anxiety, Posttraumatic Stress Disorder, and Depression in Patients With Coronary Heart Disease. ACTA ACUST UNITED AC 2004; 24:414-21. [PMID: 15632777 DOI: 10.1097/00008483-200411000-00009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Leonard A Doerfler
- University of Massachusetts Medical School, Worcester, Massachusetts, USA.
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Reuter K, Raugust S, Bengel J, Härter M. Depressive symptom patterns and their consequences for diagnosis of affective disorders in cancer patients. Support Care Cancer 2004; 12:864-70. [PMID: 15480816 DOI: 10.1007/s00520-004-0694-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2004] [Accepted: 08/17/2004] [Indexed: 11/30/2022]
Abstract
GOALS OF WORK In order to obtain references for adequate diagnostic procedures of depressive syndromes in cancer patients, the present study analyzes first the prevalence of somatic, emotional, and cognitive symptoms of depression. In a second part, the ability of diagnostic procedures to discriminate between patients with and without comorbid affective disorder is investigated. PATIENTS AND METHODS From a cross-sectional survey investigating comorbid mental disorders in cancer patients with standardized clinical assessment, a subsample of 71 patients with current affective disorders and depressive symptoms according to the Diagnostic and Statistic Manual of Mental Disorders, 4th edition (DSM-IV) were analyzed. In addition to patients' symptom patterns, a discriminant analysis including all depressive symptoms was conducted. MAIN RESULTS Cognitive symptoms are less prevalent in cancer patients than somatic and emotional symptoms. Loss of interest discriminated best between patients with and without diagnosis of comorbid affective disorder. Additionally, decreased energy and fatigue proved to have discriminatory value. CONCLUSIONS Cognitive symptoms should receive special attention in diagnostic procedures for affective disorders in cancer patients. In spite of possible symptom overlap with the cancer disease and its treatment, fatigue proves to be a useful criteria for diagnosis of depression.
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Affiliation(s)
- Katrin Reuter
- Department of Psychiatry and Psychotherapy, Freiburg University Medical Center, Hauptstrasse 5, 79104, Freiburg, Germany.
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Ketterer MW, Denollet J, Chapp J, Thayer B, Keteyian S, Clark V, John S, Farha AJ, Deveshwar S. Men deny and women cry, but who dies? Do the wages of "denial" include early ischemic coronary heart disease? J Psychosom Res 2004; 56:119-23. [PMID: 14987973 DOI: 10.1016/s0022-3999(03)00501-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2002] [Accepted: 06/11/2003] [Indexed: 10/26/2022]
Abstract
OBJECTIVES In this study patients with documented ischemic coronary heart disease (ICHD; prior MI or CAD per catheterization) were tested for the association of various measures of emotional distress with Age at Initial Diagnosis. METHODS The measures were chosen because of a published track record at predicting mortality in this population. Females were oversampled to achieve equivalent numbers of each sex (n=50), and thus equivalent statistical power. In a subset of patients (38 males and 32 females), Spouse/Friend Ketterer Stress Symptom Frequency Checklists (KSSFCs) were received. RESULTS Females reported more depression and anxiety than males. However, spouses or friends reported more anger for males. Denial (spouse/friend minus self-ratings) was greater in males for all three scales of the KSSFC (Anger, P=.005; Depression, P=.024; Anxiety, P=.001). Although females showed the same trend, self and spouse or friend ratings of distress were significantly associated with Age at Initial Diagnosis only in males. When split at the sample mean on the Spouse/Friend KSSFC AIAI (Anger) scale, Age at Initial Diagnosis occurred 14.2 years earlier in males. CONCLUSIONS Use of a significant other in assessing psychosocial/emotional distress in males may confer greater accuracy, and therefore predictive power for clinical endpoints.
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Affiliation(s)
- M W Ketterer
- Department of Psychology, Tilburg University, The Netherlands.
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Glassman A, Shapiro PA, Ford DE, Culpepper L, Finkel MS, Swenson JR, Bigger JT, Rollman BL, Wise TN. Cardiovascular health and depression. J Psychiatr Pract 2003; 9:409-21. [PMID: 15985964 DOI: 10.1097/00131746-200311000-00004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Research has shown that depression increases the likelihood that otherwise healthy people will develop ischemic heart disease (IHD) and worsens the prognosis of patients who already have IHD. Moreover, concerns about safety (e.g., cardiac side effects, drug-drug interactions) have caused physicians to be hesitant about using antidepressant agents in patients with IHD. This article is based on a recent roundtable of experts who met to discuss risk, diagnosis, and treatment options for depression in patients with IHD. This article reviews clinical and epidemiological studies that have described a link between depression and the subsequent development of IHD and have examined the role of depression as a predictor of cardiac events in patients with existing IHD. The article addresses the issue of whether depression can be safely and efficaciously treated both in patients with stable IHD and in those with acute coronary syndromes. The authors discuss safety issues related to the potential for interactions between antidepressants and cardiovascular medications, the use of nonpharmacologic treatment options such as psychosocial interventions, and the effect of antidepressant therapy on quality of life in patients with IHD. The article concludes with practical clinical guidance concerning the management of depression in patients who have recently experienced myocardial infarction.
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Pedersen SS, Middel B, Larsen ML. Posttraumatic stress disorder in first-time myocardial infarction patients. Heart Lung 2003; 32:300-7. [PMID: 14528187 DOI: 10.1016/s0147-9563(03)00097-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The objectives of this study were to investigate the prevalence of posttraumatic stress disorder in patients with a first myocardial infarction compared with a random sample of healthy controls and to determine variables associated with the disorder. DESIGN A questionnaire was distributed to 112 consecutive patients 4 to 6 weeks after infarction and to 115 healthy controls selected randomly from the general population. Objective clinical measures were obtained from the patients' medical records. RESULTS Twenty-five (22%) patients qualified for a diagnosis of posttraumatic stress disorder (PTSD) compared with 8 (7%) controls with patients being more than a three-fold (OR: 3.84; 95% CI: 1.65 to 8.94) risk of having the disorder. When adjusting for other variables, the risk was reduced to above a two-fold risk (OR: 2.71; 95% CI: 0.99-7.41). In patients and controls, depression and neuroticism were associated with a diagnosis of PTSD adjusting for other variables. In patients, anxiety was associated with a diagnosis of PTSD adjusting for other variables. Left ventricular ejection fraction and symptoms of angina pectoris were not related to a diagnosis of PTSD in the patient group. CONCLUSIONS Given that previous research has shown that persons with PTSD are at increased risk of cardiovascular diseases, cardiac patients with the disorder may be at a higher risk of recurrent cardiac events. Although longitudinal studies are needed to confirm such a relationship, this disorder should not be overlooked because of its potential role in reinfarctions and mortality.
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Affiliation(s)
- Susanne Schmidt Pedersen
- Medical Psychology, Department of Psychology and Health, Tilburg University, Tilburg, The Netherlands
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40
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Abstract
This article reviews literature regarding the influence of negative emotions, specifically depression, anger/hostility, and anxiety on coronary heart disease (CHD). For each domain, evidence is presented demonstrating the deleterious effects of negative affect on health outcomes in patients with CHD. This is followed by a discussion of the manner in which emotional factors are transduced into cardiac health risk factors. The pathophysiological mechanisms by which negative emotions have been found to exert an influence on CHD are highlighted. Finally, a general overview of the outcomes of interventions designed to ameliorate the effects of these negative emotional states on cardiovascular health are reviewed. Several treatment studies are described in detail for the purpose of elaborating the types of multicomponent interventions that attempt to address negative emotions in populations with CHD.
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Freedland KE, Rich MW, Skala JA, Carney RM, Dávila-Román VG, Jaffe AS. Prevalence of depression in hospitalized patients with congestive heart failure. Psychosom Med 2003; 65:119-28. [PMID: 12554823 DOI: 10.1097/01.psy.0000038938.67401.85] [Citation(s) in RCA: 313] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Prevalence estimates of depression in hospitalized patients with congestive heart failure (CHF) differ considerably across studies. This article reports the prevalence of depression in a larger sample of hospitalized patients with CHF and identifies demographic, medical, psychosocial, and methodological factors that may affect prevalence estimates. METHODS A modified version of the Diagnostic Interview Schedule was administered to a series of 682 hospitalized patients with CHF to determine the prevalence of DSM-IV major and minor depression; 613 patients also completed the Beck Depression Inventory. Medical, demographic, and social data were obtained from hospital chart review, echocardiography, and patient interview. RESULTS In the sample as a whole, 20% of the patients met the DSM-IV criteria for a current major depressive episode, 16% for a minor depressive episode, and 51% scored above the cutoff for depression on the Beck Depression Inventory (>or=10). However, the prevalence of major depression differed significantly between strata defined by the functional severity of heart failure, age, gender, employment status, dependence in activities of daily living, and past history of major depression. For example, the prevalence ranged from as low as 8% among patients in New York Heart Association class I failure to as high as 40% among patients in class IV. CONCLUSIONS The prevalence of depression in hospitalized patients with CHF is similar to rates found in post-myocardial infarction patients. However, it is considerably higher in certain subgroups, such as patients with class III or IV heart failure. Further research is needed on the prognostic importance and treatment of comorbid depression in CHF.
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Affiliation(s)
- Kenneth E Freedland
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri 63124, USA.
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42
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van den Brink RH, van Melle JP, Honig A, Schene AH, Crijns HJ, Lambert FP, Ormel J. Treatment of depression after myocardial infarction and the effects on cardiac prognosis and quality of life: Rationale and outline of the Myocardial INfarction and Depression-Intervention Trial (MIND-IT). Am Heart J 2002. [DOI: 10.1067/mhj.2002.123580] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Strik JJ, Honig A, Lousberg R, van Os J, van den Berg EJ, van Praag HM. Clinical correlates of depression following myocardial infarction. Int J Psychiatry Med 2002; 31:255-64. [PMID: 11841123 DOI: 10.2190/ejbr-dwlh-ev3p-twhx] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Post-MI depression increases mortality, especially in the first 18 months after MI. Identifying patients at risk for post-MI depression is therefore important. In the present study we investigated possible correlates for post-MI depression on an a priori basis. METHOD Based on the literature, four clinically easily attainable variables were selected as possible correlates for post-MI depression. These were prescription of benzodiazepines during acute hospitalization, cardiac complications during acute hospitalization, history of depression, and not being able to stop smoking within six months after MI. A consecutive cohort of 173 first-MI patients was screened with the SCL-90 depression scale and DSM-III-R criteria for major depression. Of this cohort 35 depressed patients were compared with 35 non-depressed post-MI patients, matched for gender, age, and severity of MI. RESULTS In univariate analyses, complications during hospitalisation (OR = 2.14; CI = 0.89-5.14), prescription of benzodiazepines (OR = 3.67; CI = 1.11-12.1), history of depression (OR = 3.0; CI = 0.87-10.4), and not being able to stop smoking (OR = 4.5; CI = 1.11-18.2) were clinical correlates for post-MI depression. Multivariate analyses showed that none of these variables were independent of the others in predicting depression. CONCLUSIONS A number of easily measurable patient characteristics identify those MI-patients at risk of post-MI depression. Further investigations should focus on the predictive value of these factors in relation to post-MI depression.
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Affiliation(s)
- J J Strik
- Academic Hospital Maastricht/Maastricht University, The Netherlands
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44
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Nelson LA, Abu-Shanab JR. Management of Depression in Patients with Comorbid Cardiovascular Disease. J Pharm Pract 2001. [DOI: 10.1177/089719001129040874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Evidence suggests that depression commonly occurs in patients with cardiovascular disease and is associated with a poor prognosis including increased risk of cardiac mortality. Proposed pathophysiologic mechanisms include decreased heart rate variability, altered sympathetic and parasympathetic activity, increased ventricular instability, and abnormal platelet reactivity. Other proposed mechanisms involve the interference of depression with medication adherence and cardiac risk factor reduction. Despite this evidence, depression during cardiovascular disease is commonly unrecognized and inadequately treated. Tricyclic antidepressants (TCA) are efficacious for treating depression in this population but cause serious cardiac side effects and should be avoided in patients with significant cardiovascular disease. More recent studies with bupropion and the selective serotonin reuptake inhibitors (fluoxetine, paroxetine, sertraline) indicate that they are acceptable alternatives to TCAs with regard to cardiac risk in depressed patients with heart disease, although larger studies are needed to validate their safety and efficacy in this special population. There are 3 studies currently being conducted to investigate the effect of antidepressant therapy and/or psychotherapy on cardiac morbidity and mortality in post–myocardial infarction patients with depression and/or low social support. These studies will hopefully answer the long-posed question of whether appropriate treatment of depression can improve cardiac prognosis.
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Affiliation(s)
- Leigh Anne Nelson
- St. Louis College of Pharmacy, Division of Pharmacy Practice, 4588 Parkview Place, St. Louis, MO 63110 and Assistant Professor of Psychiatry, Saint Louis University School of Medicine
| | - Joy R. Abu-Shanab
- St. Louis College of Pharmacy, Division of Pharmacy Practice, 4588 ParkviewPlace, St. Louis, MO63110
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45
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Burg MM, Abrams D. Depression in chronic medical illness: the case of coronary heart disease. J Clin Psychol 2001; 57:1323-37. [PMID: 11590618 DOI: 10.1002/jclp.1100] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Depression is an important predictor of morbidity and mortality in patients with coronary disease, particularly after myocardial infarction, independent of previous cardiac history or CAD severity. Depression also is associated with poor long-term psychosocial outcomes. The prevalence of major depression among post-MI patients is 15 to 20%, with an additional 27% reporting symptoms of minor depression. This article briefly reviews the literature on depression in patients with coronary disease, including previously published efforts to treat the disorder in this group. A case review then is provided, highlighting important aspects of treatment.
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Affiliation(s)
- M M Burg
- Health Psychology Section, VA Connecticut Healthcare System, West Haven, CT 06516, USA.
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Valkamo M, Hintikka J, Niskanen L, Koivumaa-Honkanen H, Honkalampi K, Viinamäki H. Depression and associated factors in coronary heart disease. SCAND CARDIOVASC J 2001; 35:259-63. [PMID: 11759120 DOI: 10.1080/14017430152581378] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
OBJECTIVE To investigate whether depression was associated with cardiac status and socio-demographic factors in patients with coronary heart disease (CHD). METHODS The sample consisted of 144 symptomatic patients with CHD. For screening depression the Beck Depression Inventory was administered on the day before elective coronary angiography. RESULTS Twenty-four per cent of patients had probable depressive disorder, but none of them had been previously identified as suffering from depression, or been treated for depression. Alexithymia and dissatisfaction with life were common in depressed patients. Logistic regression analysis showed that neither the cardiac status nor sociodemographic factors were associated with depression. CONCLUSION Depression is a common finding and should be looked for independently of other risk factors in patients with CHD.
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Affiliation(s)
- M Valkamo
- Department of Psychiatry, Kuopio University Hospital, Kuopio, Finland
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47
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Strik JJ, Honig A, Lousberg R, Denollet J. Sensitivity and specificity of observer and self-report questionnaires in major and minor depression following myocardial infarction. PSYCHOSOMATICS 2001; 42:423-8. [PMID: 11739910 DOI: 10.1176/appi.psy.42.5.423] [Citation(s) in RCA: 184] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This study evaluated screening abilities of self-report questionnaires for depression in first myocardial infarction (MI) patients. One month post-MI, 206 patients with first MI were screened for major and minor depression using the 90-item Symptom Check List (SCL-90), the Beck Depression Inventory (BDI), the Hospital Anxiety and Depression Scale (HADS), and the 17-item Hamilton Depression Rating Scale (Ham-D). The Structured Clinical Interview for DSM-IV criteria was used as the gold standard. Sensitivity and specificity for different cutoff points, using relative operating characteristics curves, were assessed. The internal consistency for all scales was good. When screening for major and minor depression, the optimal cutoff scores are lower than those for screening major depression only. The SCL-90, BDI, HADS, and Ham-D proved to have acceptable abilities for screening post-MI major and minor depression.
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Affiliation(s)
- J J Strik
- Department of Psychiatry, Academic Hospital Maastricht/Maastrict University, The Netherlands
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48
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Strik JJ, Honig A, Maes M. Depression and myocardial infarction: relationship between heart and mind. Prog Neuropsychopharmacol Biol Psychiatry 2001; 25:879-92. [PMID: 11383983 DOI: 10.1016/s0278-5846(01)00150-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
There is a relationship between depression and Myocardial Infarction (MI) as higher levels of depression and severe depression (major vs minor) are associated with higher morbidity and mortality due to cardiac events, which are mainly caused by arrhythmia. Second, severity of MI is not or even inversely related to development of depression. Depression post-MI goes often unrecognized as only 10% of depressed MI patients are diagnosed as such. This underestimation of depression is attributed to its atypical profile, tendency of physicians to interpret depressive symptoms as a transient and 'natural' reaction to a life-threatening event, and the scarce knowledge of risk factors associated with development of post-MI depression. During the first 18 months following MI major depression occurs in 15-30% of patients. Depression should be assessed in an early stage as depression has the highest prevalence in hospital and in the first 6 months post-MI. Risk factors for developing post-MI depression include complications during hospitalization, prescription of benzodiazepines during hospitalisation, previous history of depression, and not being able to stop smoking. Selective Serotonin Reuptake Inhibitors (SSRIs) appear to be first choice treatment in post-MI depression. As yet there is no information on the efficacy and safety of Serotonin and Noradrenalin Reuptake Inhibitors (SNRIs).
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Affiliation(s)
- J J Strik
- Department of Psychiatry, Academic Hospital Maastricht, The Netherlands
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49
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Abstract
Some degree of depression affects at least 30% of hospitalized patients with coronary artery disease (CAD), and is associated with increased risks of mortality and continuing depression over at least the first year following hospital discharge. Despite its consequences for prognosis and quality of life, depression is underrecognized and undertreated in cardiac patients. The diagnosis of depression is complicated in patients with medical illness. Their symptoms can reflect physical as well as psychological complaints. Many CAD patients resist the idea of additional medications, and drug interactions can be problematic for those willing to accept antidepressant treatment. Finally, depression tends to recur. Its successful treatment requires a long-term commitment from both physician and patient. This article examines the special challenges involved in diagnosing depression in patients with CAD, outlines available psychotherapeutic and pharmacological treatments, and considers the issues involved in deciding which patients to treat, with what approach, and for how long.
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Affiliation(s)
- F Lespérance
- Research Center, Montreal Heart Institute, Montreal, Quebec, Canada.
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50
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Sullivan M, LaCroix A, Russo J, Swords E, Sornson M, Katon W. Depression in coronary heart disease. What is the appropriate diagnostic threshold? PSYCHOSOMATICS 1999; 40:286-92. [PMID: 10402872 DOI: 10.1016/s0033-3182(99)71220-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The purpose of this study was to determine the threshold at which depression becomes important for the daily functioning of patients with heart disease. Data from a 1-year prospective cohort study of health maintenance organization patients undergoing coronary angiography for coronary heart disease were analyzed for differences in a standardized composite measure of functioning. Patients with major depression (N = 19) and patients with minor depression (N = 28) were significantly more functionally impaired at baseline and at 1-year follow-up than those with no depression (N = 110). The major and minor depression groups did not differ significantly. The significance of the depression group differences was reduced, but not eliminated, when controlling for differences in reported heart symptoms.
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Affiliation(s)
- M Sullivan
- Center for Health Studies and Group Health Cooperative, Seattle, Washington, USA.
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