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Garrels E, Kainth T, Silva B, Yadav G, Gill G, Salehi M, Gunturu S. Pathophysiological mechanisms of post-myocardial infarction depression: a narrative review. Front Psychiatry 2023; 14:1225794. [PMID: 37599890 PMCID: PMC10436342 DOI: 10.3389/fpsyt.2023.1225794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 07/13/2023] [Indexed: 08/22/2023] Open
Abstract
Myocardial infarction (MI) can have significant physical and mental consequences. Depression is a prevalent psychiatric condition after MI which can reduce the quality of life and increase the mortality rates of patients. However, the connection between MI and depression has remained under-appreciated. This review examines the potential connection between depression and MI by overviewing the possible pathophysiologic mechanisms including dysregulation of the hypothalamic-pituitary-adrenal axis and autonomic nervous system, coagulation system dysfunction, inflammation, environmental factors, as well as, genetic factors. Furthermore, depression can be an adverse event of medications used for MI treatment including beta-blockers, statins, or anti-platelet agents. The need for early detection and management of depression in patients with MI is, therefore, crucial for improving their overall prognosis. Adherence to treatments and regular follow-up visits can ensure the best response to treatment.
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Affiliation(s)
- Eric Garrels
- Department of Psychiatry, BronxCare Health System, New York, NY, United States
| | - Tejasvi Kainth
- Department of Psychiatry, BronxCare Health System, New York, NY, United States
| | - Briana Silva
- BronxCare Health System, New York, NY, United States
| | - Garima Yadav
- Department of Psychiatry, BronxCare Health System, New York, NY, United States
| | - Gurtej Gill
- Department of Psychiatry, BronxCare Health System, New York, NY, United States
| | - Mona Salehi
- BronxCare Health System, New York, NY, United States
| | - Sasidhar Gunturu
- Department of Psychiatry, BronxCare Health System, New York, NY, United States
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
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DETECTION AND ASSESSMENT OF DISORDERS OF THE DEPRESSIVE SPECTRUM IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION DEPENDING ON THE METHOD OF TREATMENT. WORLD OF MEDICINE AND BIOLOGY 2022. [DOI: 10.26724/2079-8334-2022-4-82-107-111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Khan Z, Musa K, Abumedian M, Ibekwe M. Prevalence of Depression in Patients With Post-Acute Coronary Syndrome and the Role of Cardiac Rehabilitation in Reducing the Risk of Depression: A Systematic Review. Cureus 2021; 13:e20851. [PMID: 35141096 PMCID: PMC8802655 DOI: 10.7759/cureus.20851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2021] [Indexed: 11/30/2022] Open
Abstract
Patients with acute myocardial infarction (AMI) or ischaemic heart disease are at risk of developing anxiety and depression. This systematic review aims to identify the various risk factors and the role of cardiac rehabilitation in reducing the risk of depression in patients after AMI. In this review, we included data on the prevalence of depression in patients post-AMI for the years 2016-2017 from a cardiac rehabilitation unit at Morriston Hospital, Swansea, a primary coronary angioplasty centre. Results from our meta-analysis were compared with the findings of previous studies. Our data showed the prevalence of depression to be 14% pre-cardiac rehabilitation and 3% post-cardiac rehabilitation. A meta-analysis of seven studies showed the prevalence to be approximately 20-35% depending on the type of questionnaire or screening method used. Gender, marital status, age, and sedentary lifestyle were found to be risk factors for depression post-acute coronary syndrome (ACS). Females, patients aged >65 years, and those who were single, lived alone, or widowed were at a higher risk of depression, and patients with sedentary lifestyles were more likely to have post-ACS depression. Depression in patients post-myocardial infarction was also associated with increased mortality and morbidity risk as well as higher hospital re-admission and future cardiac events. The meta-analysis showed significant publication bias, studies with negative results were less likely to be published, and the study data were heterogeneous. The pooled estimate for depression estimated using the random-effects model was 1.78 (95% confidence interval = 1.58-2.01).
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Bruyninx G, Grenier J, Greenman PS, Tassé V, Abdulnour J, Chomienne MH. Prevalence of Symptoms of Anxiety Disorders and Depression in Cardiac Rehabilitation Patients in an Academic Hospital: a Case Study. Psychiatr Q 2021; 92:273-287. [PMID: 32621076 DOI: 10.1007/s11126-020-09791-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The relationship between body and mind is increasingly recognized in the occurrence and prognosis of cardiac disease. Based on reports detailing the potential (and the influence of certain risk factors) of developing depression and anxiety following cardiovascular disease, or a cardiac event, most notably acute coronary syndrome (ACS), we investigated whether such symptoms also existed in patient cases found at the cardiac rehabilitation unit of an academic hospital of Eastern Ontario. We examined data from charts during a 6-year period (2012-2017). The Hospital Anxiety and Depression Scale cumulated data within a retrospective cross-sectional study, was used to estimate the prevalence of anxious and depressive symptoms that might reflect the presence of psychological distress. Overall, our sample included 1178 patient files, 81.3% of which were diagnosed with ACS and 69.6% were male. 63.1% of the patients were between 60 and 79 years old at the time of diagnosis. Most patients were Caucasian (81.1%), married (60.3%), and living with their family (74.3%), and 49.7% were recorded as overweight or obese. We found that 29.3% of patients reported symptoms of psychological distress. Regression analyses revealed strong negative correlations between the proportion of symptoms of psychological distress and factors like age and functional capacity as measured by metabolic equivalents. Significant associations were also established between symptoms of psychological distress and factors such as obesity, sedentary lifestyle, smoking, and sex (female). This study was undertaken as part of a business case to implement a new cardiac rehabilitation programme in an academic hospital of Eastern Ontario and illustrate to the managers and decision-makers, the important factors to consider and to target when developing a stepped-care program for patients in cardiac rehabilitation in order to prevent psychological distress and how such a program was relevant to their institution.
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Affiliation(s)
- Gladys Bruyninx
- Institut du Savoir Montfort, 745a chemin Montréal, Ottawa, Ontario, K1K 0T2, Canada.
- Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, Ontario, K1H 8M5, Canada.
| | - Jean Grenier
- Institut du Savoir Montfort, 745a chemin Montréal, Ottawa, Ontario, K1K 0T2, Canada
| | - Paul S Greenman
- Institut du Savoir Montfort, 745a chemin Montréal, Ottawa, Ontario, K1K 0T2, Canada
- Université du Québec en Outaouais, 283, boul. Alexandre-Taché, Gatineau, Québec, J8X 3X7, Canada
| | - Vanessa Tassé
- Institut du Savoir Montfort, 745a chemin Montréal, Ottawa, Ontario, K1K 0T2, Canada
| | - Joseph Abdulnour
- Institut du Savoir Montfort, 745a chemin Montréal, Ottawa, Ontario, K1K 0T2, Canada
| | - Marie Hélène Chomienne
- Institut du Savoir Montfort, 745a chemin Montréal, Ottawa, Ontario, K1K 0T2, Canada
- Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, Ontario, K1H 8M5, Canada
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Mujtaba SF, Sial JA, Karim M. Depression and Anxiety in patients undergoing Percutaneous Coronary Intervention for Acute Coronary Syndrome. Pak J Med Sci 2020; 36:1100-1105. [PMID: 32704297 PMCID: PMC7372680 DOI: 10.12669/pjms.36.5.1749] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background and Objective Depression and anxiety are very common in patients with cardiac diseases. Percutaneous coronary intervention (PCI) has not only decreased mortality but angina, heart failure and recurrent hospitalization all are improved. Therefore, anxiety and depression associated with fibrinolytic therapy in acute coronary syndrome (ACS) are expected to be decreased in the patient undergoing PCI. Therefore, the aim of this study was to determine prevalence of depression and anxiety in patients undergoing percutaneous coronary intervention for acute coronary syndrome. Methods This study was conducted at Larkana Satellite Center of National Institute of Cardiovascular Diseases (NICVD), Pakistan from August 2018 to December 2018. Patients who underwent cardiac intervention within one month were enrolled in this study. Patients were interviewed regarding their basic demographics, indication for intervention and procedure details. Symptoms of anxiety were assessed using the translation of inventory of SAS (Zung's Self-Rating Anxiety Scale). Patients were interviewed for depression by using Becks depression inventory (BDI). Results A total of 153 patients were included in this study out of which 118 (77.1%) were males and 35 (22.5%) were females. All were married except one. Diabetes mellitus (DM) was present in 61 (39.9%), hypertension (HTN) in 69 (45.15%), obesity in 15 (9.8%), and 40 (26.1%) were smokers. Depression was present in 16 (10.5%) patients and anxiety was present in 12 (7.5%) of patients. On analysis of the association of various factor with depression; non-diabetics, housewives, laborers and uneducated were found to be more depressed. While those who smoke or earn more than 50 thousand were found less likely to be depressed. Conclusion Both depression and anxiety were present in only 10.5% and 7.5% of the patients after percutaneous coronary intervention for acute coronary syndrome.
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Affiliation(s)
- Syed Fayaz Mujtaba
- Syed Fayaz Mujtaba, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Jawaid Akbar Sial
- Jawaid Akbar Sial, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Musa Karim
- Musa Karim, National Institute of Cardiovascular Diseases, Karachi, Pakistan
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Serpytis P, Navickas P, Lukaviciute L, Navickas A, Aranauskas R, Serpytis R, Deksnyte A, Glaveckaite S, Petrulioniene Z, Samalavicius R. Gender-Based Differences in Anxiety and Depression Following Acute Myocardial Infarction. Arq Bras Cardiol 2018; 111:676-683. [PMID: 30156607 PMCID: PMC6248233 DOI: 10.5935/abc.20180161] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 05/23/2018] [Indexed: 01/31/2023] Open
Abstract
Background Among patients with heart disease, depression and anxiety disorders are
highly prevalent and persistent. Both depression and anxiety play a
significant role in cardiovascular disease progression and are acknowledged
to be independent risk factors. However, there is very little gender-related
analysis concerning cardiovascular diseases and emotional disorders. Objective We aimed to evaluate depression and anxiety levels in patients suffering from
myocardial infarction [MI] within the first month after the MI and to assess
the association between cardiovascular disease risk factors, demographic
indicators and emotional disorders, as well as to determine whether there
are gender-based differences or similarities. Methods This survey included demographic questions, clinical characteristics,
questions about cardiovascular disease risk factors and the use of the
Hospital Anxiety and Depression Scale [HADS]. All statistical tests were
two-sided, and p values < 0.05 were considered statistically
significant. Results It was determined that 71.4% of female and 60.4% of male patients had
concomitant anxiety and/or depression symptomatology (p = 0.006). Using men
as the reference point, women had an elevated risk of having some type of
psychiatric disorder (odds ratio, 2.86, p = 0.007). The HADS-D score was
notably higher in women (8.66 ± 3.717) than men (6.87 ± 4.531,
p = 0.004). It was determined that male patients who developed depression
were on average younger than those without depression (p = 0.005). Conclusions Women demonstrated an elevated risk of having anxiety and/or depression
disorder compared to men. Furthermore, depression severity increased with
age in men, while anxiety severity decreased. In contrast, depression and
anxiety severity was similar for women of all ages after the MI. A higher
depression score was associated with diabetes and physical inactivity,
whereas a higher anxiety score was associated with smoking in men.
Hypercholesterolemia was associated with both higher anxiety and depression
scores, and a higher depression score was associated with physical
inactivity in women.
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Affiliation(s)
- Pranas Serpytis
- Vilnius University - Faculty of Medicine, Vilnius - Lithuania.,Vilnius University Hospital Santaros Clinics, Vilnius - Lithuania.,Clinic of Emergency Medicine - Vilnius University, Vilnius - Lithuania
| | - Petras Navickas
- Vilnius University - Faculty of Medicine, Vilnius - Lithuania
| | | | | | | | - Rokas Serpytis
- Vilnius University - Faculty of Medicine, Vilnius - Lithuania.,Vilnius University Hospital Santaros Clinics, Vilnius - Lithuania
| | - Ausra Deksnyte
- Vilnius University - Faculty of Medicine, Vilnius - Lithuania
| | - Sigita Glaveckaite
- Vilnius University - Faculty of Medicine, Vilnius - Lithuania.,Vilnius University Hospital Santaros Clinics, Vilnius - Lithuania
| | - Zaneta Petrulioniene
- Vilnius University - Faculty of Medicine, Vilnius - Lithuania.,Vilnius University Hospital Santaros Clinics, Vilnius - Lithuania
| | - Robertas Samalavicius
- Vilnius University - Faculty of Medicine, Vilnius - Lithuania.,Vilnius University Hospital Santaros Clinics, Vilnius - Lithuania
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Ivanovs R, Kivite A, Ziedonis D, Mintale I, Vrublevska J, Rancans E. Association of depression and anxiety with cardiovascular co-morbidity in a primary care population in Latvia: a cross-sectional study. BMC Public Health 2018; 18:328. [PMID: 29510681 PMCID: PMC5840840 DOI: 10.1186/s12889-018-5238-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 02/28/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Cardiovascular (CV) diseases (CVDs) are the leading cause of mortality worldwide. Globally, there is a growing interest in understanding and addressing modifiable psychosocial risk factors, particularly depression and anxiety, to prevent CVDs and to reduce morbidity and mortality. Despite the high premature mortality rate from CVDs in Latvia, this is the first Latvian study to examine the association of depression and anxiety with CVD morbidity in a primary care population. METHODS This cross-sectional study was carried out in 2015 within the framework of the National Research Program BIOMEDICINE at 24 primary care facilities throughout Latvia. Consecutive adult patients during a one-week time period at each facility were invited to join the study. Assessments onsite included a 9-item Patient Health Questionnaire (PHQ-9) and a 7-item Generalized Anxiety Disorder scale (GAD-7) followed by a socio-demographic questionnaire and measurements of height, weight, waist circumference, blood pressure, and total cholesterol. The diagnostic Mini International Neuropsychiatric Interview (MINI) was conducted over the telephone within 2 weeks after the visit to the general practitioner. A multivariate model was developed using binary logistic regression. RESULTS From the 1565 subjects (31.2% male), CVD was detected in 17.1%. Depression screening was positive (PHQ-9 ≥ 10) for 14.7%, and anxiety screening was positive (GAD-7 ≥ 10) for 10.1% of the study subjects. According to the MINI, 10.3% had current and 28.1% had lifetime depressive episode, and 16.1% had an anxiety disorder. Depression, not anxiety, was statistically significantly related to CVDs with an odds ratio (OR) of 1.52 (p = 0.04) for current depressive symptoms (PHQ-9 ≥ 10) and 2.08 (p = 0.002) for lifetime depressive episode (MINI). CONCLUSIONS Current depressive symptoms (PHQ-9 ≥ 10) and a lifetime depressive episode (according to the MINI) were significantly associated with increased risk of CV morbidity. Therefore, CV patients should be screened and treated for depression to potentially improve the prognosis of CVDs. Enhanced training and integration of mental health treatment in Latvian primary care settings may improve clinical outcomes.
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Affiliation(s)
- R Ivanovs
- Department of Psychiatry and Narcology, Riga Stradins University, 2 Tvaika Str, Riga, LV-1005, Latvia.
| | - A Kivite
- Department of Public Health and Epidemiology, Riga Stradins University, 9 Kronvalda Ave, Riga, LV-1010, Latvia
| | - D Ziedonis
- Associate Vice Chancellor for Health Sciences, University of California San Diego, Biomedical Sciences Building, Room 1310, 9500 Gilman Drive #0602, La Jolla, CA, 92093, USA
| | - I Mintale
- Department of Cardiology, University Clinic of Paul Stradins, 13 Pilsonu Str, Riga, LV-1002, Latvia
| | - J Vrublevska
- Department of Psychiatry and Narcology, Riga Stradins University, 2 Tvaika Str, Riga, LV-1005, Latvia
| | - E Rancans
- Department of Psychiatry and Narcology, Riga Stradins University, 2 Tvaika Str, Riga, LV-1005, Latvia
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