Heartache and heartbreak--the link between depression and cardiovascular disease. Nat Rev Cardiol. 2012;9:526-539. [PMID: 22733213 DOI: 10.1038/nrcardio.2012.91]

Prophylactic administration of rosmarinic acid ameliorates depression-associated cardiac abnormalities in Wistar rats: Evidence of serotonergic, oxidative, and inflammatory pathways

Psychiatric disorders and associated cardiac comorbidities have increased the risk of mortality worldwide. Researchers reported that depression increases the possibility of future cardiac abnormalities by approximately 30%. Therefore, there is an unmet need to develop therapeutic interventions to treat depression and associated cardiac abnormalities. The present study was conducted to evaluate the prophylactic effect of rosmarinic acid (RA) against chronic unpredictable stress (CUS)-induced depression associated cardiac abnormalities in Wistar rats. The CUS paradigm, which comprised several stressors, was employed for 40 days to induce depressive-like behavior and associated cardiac abnormalities in rats. Along with CUS, RA at a dose of 25 and 50 mg/kg was administered orally to two groups of animals for 40 days. Behavioral tests (forced swim test and sucrose consumption test) and molecular biomarkers (corticosterone and serotonin) were performed. Electrocardiography was performed before CUS (Day 0), Day 20, and Day 40 to study electrocardiogram parameters. Furthermore, changes in body weight, organ weight, tissue lipid peroxidation, glutathione, catalase, cTn-I, MMP-2, and proinflammatory cytokines (TNF-α and IL-6) were estimated. Our results showed that RA treatment caused a reduction in immobility period, adrenal hyperplasia, corticosterone level, tissue lipid peroxidation, cTn-I, MMP-2, proinflammatory cytokines, and QRS complex duration, while an increase in sucrose consumption, brain serotonin level, T-wave width, glutathione, and catalase activity as compared with the CUS-control group. The results of our study proved that RA administration ameliorates CUS-induced depression-associated cardiac abnormalities in rats via serotonergic, oxidative, and inflammatory pathways.

Depressive symptoms and allostatic load have a bidirectional association among Puerto Rican older adults

BACKGROUND

Depression is strongly associated with chronic disease; yet, the direction of this relationship is poorly understood. Allostatic load (AL) provides a framework for elucidating depression-disease pathways. We aimed to investigate bidirectional, longitudinal associations of baseline depressive symptoms or AL with 5-year AL or depressive symptoms, respectively.

METHODS

Data were from baseline, 2-year, and 5-year visits of 620 adults (45-75 years) enrolled in the Boston Puerto Rican Health Study. The Center for Epidemiology Studies Depression (CES-D) scale (0-60) captured depressive symptoms, which were categorized at baseline as low (<8), subthreshold (8-15), or depression-likely (⩾16) symptoms. AL was calculated from 11 parameters of biological functioning, representing five physiological systems. Baseline AL scores were categorized by the number of dysregulated parameters: low (0-2), moderate (3-5), or high (⩾6) AL. Multivariable, multilevel random intercept and slope linear regression models were used to examine associations between 3-category baseline CES-D score and 5-year continuous AL score, and between baseline 3-category AL and 5-year continuous CES-D score.

RESULTS

Baseline subthreshold depressive symptoms [(mean (95% CI)): 4.8 (4.5-5.2)], but not depression-likely symptoms [4.5 (4.2-4.9)], was significantly associated with higher 5-year AL scores, compared to low depressive symptoms [4.3 (3.9-4.7)]. Baseline high AL [19.4 (17.6-21.2)], but not low AL [18.5 (16.5-20.6)], was significantly associated with higher 5-year CES-D score, compared to baseline moderate AL [16.9 (15.3-18.5)].

CONCLUSIONS

Depressive symptoms and AL had a bi-directional relationship over time, indicating a nuanced pathway linking depression with chronic diseases among a minority population.

The effect of polluting cooking fuels on depression among older adults in six low- and middle-income countries

BACKGROUND

Little is known about the association between polluting cooking fuel and depression among older adults living in low- and middle-income countries (LMICs).

OBJECTIVE

To evaluate the association between polluting cooking fuel and depression in older population of LMICs.

METHODS

We derived data from WHO Study on global AGEing and adult health (SAGE), which was conducted in six LMICs including China, India, Ghana, South Africa, Mexico and Russia. We applied logistic regression with the propensity score method to examine the relationship of polluting cooking fuel and depression among adults ≥50 years old.

RESULTS

Overall, the odds ratio (OR) of depression was 1.57 [95% confidence intervals (CIs), 1.26-1.93] for older adults relying on polluting cooking fuel in six LMICs. In India and China, polluting cooking fuel was associated with depression with ORs of 2.06 (95%CI, 1.44-2.94) and 1.59 (95%CI, 1.01-2.49), respectively. Positive OR of depression was identified for those polluting cooking fuel users aged over 65 years old (OR, 1.65; 95%CI,1.16-2.36) and those aged 50-65 (OR, 1.50; 95%CI,1.14-1.97). Polluting cooking fuel was associated with depression for females (OR, 1.80; 95%CI, 1.32-2.46), however we did not observe significant association for males. Positive effect of polluting cooking fuel was identified in both rural (OR, 1.72; 95%CI, 1.26-2.34) and urban areas (OR, 1.44; 95%CI, 1.07-1.95). For individuals relying on solid fuel, cooking in a room used for living/sleeping and using open stove/fire was associated with depression with ORs of 1.30 (95%CI, 1.14-1.48) and 1.15 (95%CI, 1.01-1.31), respectively. However, no significant effect was identified for hood.

CONCLUSION

Polluting cooking fuel was related to depressive symptoms among older adults in LMICs. In addition, cooking ventilation could be useful intervention to control health hazard of solid fuel.

Effect of Low-Dose Statins in Addition to Standard Therapy on Brain Perfusion and Neurocognitive Performance in Patients with Major Depressive Disorder

INTRODUCTION

Major depressive disorder (MDD) is a prevalent condition which has a well-known association with ischemic cardiomyopathy, probably explained by an inflammatory mediator mechanism. Statins, besides reducing cholesterol production, have pleiotropic effects including anti-inflammatory activity. The goal was to evaluate the effect of statins as an addition to standard therapy on mood status, brain perfusion, and neurocognitive performance in MDD.

METHODS

We studied 20 MDD patients with brain single-photon emission tomography and Cambridge Neuropsychological Test Automated Battery (CANTAB), half randomized to 10 mg of Rosuvastatin or placebo, in addition to selective serotonin reuptake inhibitors (SSRIs) therapy and being reevaluated 3 months later. The images were compared using Statistical Parametric Mapping; clinical scores (Hamilton Depression Score with 17 items and Beck's Depression Inventory) as well as neurocognitive parameters were applied as covariances (CoV) to estimate regional cerebral blood flow (rCBF) changes with both therapies.

RESULTS

Clinical scores decreased in both groups (p = 0.0001); Beck's presented a larger decrease with statins. We observed significantly rCBF changes expressed as significant larger clusters of voxels (p < 0.05) in the pre/subgenual anterior cingulate plus orbitofrontal cortex and a small area in the posterior cingulate gyrus in the statins group, whereas it was not observed with placebo, when using clinical scores as CoV. A similar pattern of rCBF changes was present with emotions recognition, attentional, paired associates learning, spatial planning, and working memory tasks.

CONCLUSION

Short-term use of low-dose statins in MDD patients under SSRIs results in important rCBF changes in key mood associated areas to improvement in neurocognitive performance. These findings, even though demonstrated in a small sample, could open a new therapeutic tool in the comprehensive management of this disorder.

Depression and cardiovascular risk in primary care patients

OBJECTIVE

This study assessed the relationship of both depression diagnosis and clinically significant depressive symptoms with individual cardiovascular risk factors and estimated total cardiovascular risk in primary care patients.

METHODS

This study used a cross-sectional and retrospective design. Patients who had a primary care encounter between January 2016 and September 2018 and completed depression screening (PHQ-9) during the year prior to their appointment (N = 70,980) were included in this study. Data examining estimated total cardiovascular risk, specific cardiovascular risk factors, and relevant clinical diagnoses (including depression diagnosis) were extracted from the electronic health record. Patients were categorized into three groups: no depression (PHQ-9 < 10 and no depression diagnosis), controlled depression (PHQ-9 < 10 with previous depression diagnosis), and current depression (PHQ-9 ≥ 10). Groups were compared on estimated total risk and specific cardiovascular risk factors (e.g., body mass index [BMI], smoking status, lipids, blood pressure, and glucose).

RESULTS

In adjusted analyses, patients with current depression (n = 18,267) demonstrated significantly higher 10-year and 30-year cardiovascular risk compared to patients with controlled depression (n = 33,383; 10-year: b = 0.59 [95% CI = 0.44,0.74]; 30-year: OR = 1.32 [95% CI = 1.26,1.39]) and patients without depression (n = 19,330; 10-year: b = 0.55 [95% CI = 0.37,0.73]; 30-year: OR = 1.56 [95% CI = 1.48,1.65]). Except for low-density lipoprotein (LDL), patients with current depression had the greatest cardiovascular risk across specific risk factors.

CONCLUSIONS

Individuals who had a depression diagnosis and clinically significant depressive symptoms had the greatest cardiovascular risk. Pathways to prevent cardiovascular disease in those with depression might focus on treating depressive symptoms as well as specific uncontrolled cardiovascular risk factors.

Depression duration and risk of incident cardiovascular disease: A population-based six-year cohort study

BACKGROUND

Depression symptoms are significantly associated with an increased risk of cardiovascular disease (CVD). However, understanding of the magnitude of the association between depression duration and risk of CVD is limited. Therefore, we aimed to assess whether a longer duration of exposure to depression is associated with a higher risk of new-onset CVD.

METHODS

We conducted a territory-wide retrospective cohort study among patients (≥ 10 years old) with depression diagnosed between January and December 2014 in Hong Kong. The observation period spanned January 1, 2014, to December 31, 2019, and all participants had no CVD at baseline. Incidence of CVD was calculated. We used Cox proportional hazard regression to adjust confounders and estimate hazard ratios of CVD risk.

RESULTS

Among 11,651 participants with depression, 1306 (11.2%) individuals developed CVD. Multi-adjusted models showed individuals with depression duration of 2-5 years (Hazard Ratios [HRs]: 1.38 [95% confidence interval (CI): 1.19-1.60]) and ≥6 years (1.45 [1.25-1.68]) had a significantly escalated risk of developing CVD, compared to those with depression within one year. Stratified analyses indicated that the association was prominent in women and those under 65 years old.

LIMITATIONS

Lack of depression severity information and the small sample size in some subgroup analyses.

CONCLUSIONS

Longer exposure to depression is associated with significant increased risk of CVD. The interplay between mental and vascular health emphasizes the need for CVD prevention in patients with long-term depression.

Free Cholesterol Bioavailability and Atherosclerosis

PURPOSE OF REVIEW

As both a cholesterol acceptor and carrier in the reverse cholesterol transport (RCT) pathway, high-density lipoprotein (HDL) is putatively atheroprotective. However, current pharmacological therapies to increase plasma HDL cholesterol (HDL-c) concentration have paradoxically failed to prevent or reduce atherosclerosis and cardiovascular disease (CVD). Given that free cholesterol (FC) transfer between surfaces of lipoproteins and cells is reversible, excess plasma FC can be transferred to the cells of peripheral tissue sites resulting in atherosclerosis. Here, we summarize potential mechanisms contributing to this paradox and highlight the role of excess free cholesterol (FC) bioavailability in atherosclerosis vs. atheroprotection.

RECENT FINDINGS

Recent findings have established a complex relationship between HDL-c concentration and atherosclerosis. Systemic scavenger receptor class B type 1 (SR-B1) knock out (KO) mice exhibit with increased diet-induced atherosclerosis despite having an elevated plasma HDL-c concentration compared to wild type (WT) mice. The greater bioavailability of HDL-FC in SR-B1 vs. WT mice is associated with a higher FC content in multiple cell types and tissue sites. These results suggest that dysfunctional HDL with high FC bioavailability is atheroprone despite high HDL-c concentration. Past oversimplification of HDL-c involvement in cholesterol transport has led to the failures in HDL targeted therapy. Evidence suggests that FC-mediated functionality of HDL is of higher importance than its quantity; as a result, deciphering the regulatory mechanisms by which HDL-FC bioavailability can induce atherosclerosis can have far-reaching clinical implications.

STAT4 and COL1A2 are potential diagnostic biomarkers and therapeutic targets for heart failure comorbided with depression

BACKGROUND

Heart failure (HF) and depression are common disorders that markedly compromise quality of life and impose a great financial burden on the society. Although increasing evidence has supported the closely linkage between the two disorders, the comorbidity mechanisms remain to be fully illuminated. We performed a bioinformatics network analysis to understand potential diagnostic biomarkers and therapeutic targets for HF comorbided with depression.

METHODS

We downloaded the datasets of HF and depression from the Gene Expression Omnibus (GEO) database and constructed co-expression networks by Weighted Gene Co-Expression Network Analysis (WGCNA) to identify key modules. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis were performed on the common genes existing in the HF and depression related modules. Then, we employed the STRING database to construct the protein-protein interaction (PPI) network and detected the hub genes in the network. Finally, we validated the expression difference of hub genes from additional datasets of HF and depression.

RESULTS

Functional enrichment analysis indicated that platelet activation, chemokine signaling and focal adhesion were probably involved in HF comorbided with depression. PPI network construction indicated that HF comorbided with depression is likely related to 5 hub genes, including STAT4, CD83, CX3CR1, COL1A2, and SH2D1B. In validated datasets, STAT4 and COL1A2 were especially involved in the comorbidity of HF and depression.

CONCLUSION

Our work indicated a total of 5 hub genes including STAT4, CD83, CX3CR1, COL1A2, and SH2D1B, in which STAT4 and COL1A2 especially underlie the comorbidity mechanisms of HF and depression. These shared pathways might provide new targets for further mechanistic studies of the pathogenesis and treatment of HF and depression.

Food Insecurity Is Associated with Mental-Physical Comorbidities among U.S. Adults: NHANES 2013 to 2016

The co-occurrence of mental and physical conditions has increased significantly during the last decade. However, research examining the influence of social factors such as food insecurity is limited. The purpose of this study was to examine the association between food insecurity and mental–physical comorbidity status among U.S. adults. Data for this analysis were drawn from the National Health and Nutrition Examination Survey (NHANES) for the years 2013–2016. Respondents ages 18 and older who reported at least one of three chronic conditions (i.e., type 2 diabetes mellitus, hypertension, and hyperlipidemia) and responded to a nine-item depression scale were included in the analytic sample. The prevalence of food insecurity among those with depression and a cardiometabolic condition was 34% compared to 13% among those with a cardiometabolic condition only. Findings from multinomial logistic regression models indicated that food insecurity was associated with higher risk of mental–physical comorbidity (OR: 3.6, 95% CI: 2.26–5.76). Respondents reporting poor diet and poor self-reported health had higher odds of comorbid depression and cardiometabolic conditions. Female respondents had increased odds of comorbid depression and cardiometabolic conditions. Food insecurity is associated with co-occurring depression and cardiometabolic disease and may have implications for disease management.

Prognostic impact of depressive symptoms on all-cause mortality in individuals with abdominal aortic aneurysm and in the general population: a population-based prospective HUNT study in Norway

BACKGROUND

Abdominal aortic aneurysm (AAA) is a potentially life-threatening disease but the high mortality rate is linked to high age and comorbidity pattern. Depression is associated with increased mortality in the general population and individuals with cardiovascular diseases, but this is sparsely studied for AAA. The aim was to examine the prognostic impact of depressive symptoms on all-cause mortality in individuals with AAA and compare with findings in a general population of the same age and risk profile.

METHODS

Population-based prospective study including 36 616 participants (52.1% women) from the Trøndelag Health Study in Norway. A total of 9428 individuals died during a median follow-up of 10 years at ages 60-90 years. Depressive symptoms were defined by a Hospital Anxiety and Depression Scale-Depression score ≥8. Data on AAA diagnoses and death were obtained from medical records and national registers. HRs from Cox proportional hazard regression models are reported.

RESULTS

A total of 4832 (13.2%) individuals reported depressive symptoms, whereas 583 (1.6%) AAAs were identified. The adjusted hazard of death was 2.66 times higher in persons with AAA compared with the general population (95% CI 2.39 to 2.97). Overall, there was no significant adverse effect of depressive symptoms in individuals with AAA (HR 1.15;95% CI 0.88 to 1.51), whereas an increased risk was seen in the general population (HR 1.23;95% CI 1.17 to 1.30).

CONCLUSION

The overall risk of death was considerably higher in individuals with AAA compared with a general population of the same age and risk profile. Depressive symptoms did not significantly influence the risk of death in the AAA group.

Influence of the Interaction Between Depressive Symptoms and Sleep Disorders on Cardiovascular Diseases Occurrence

Purpose

Depressive symptoms and sleep disorders were independent risk factors for cardiovascular diseases (CVD). However, few studies have examined the combined effects of depressive symptoms and sleep disorders on CVD. We aimed to evaluate the association between depressive symptoms, sleep disorders and CVD occurrence.

Methods

Data on 30,398 participants were extracted from the National Health and Nutritional Examination Survey (NHANES) database (2005–2018). Univariate and multivariate analyses were used for assessing the association of depressive symptoms, sleep disorders, and CVD occurrence. Three indexes, including the relative excess risk of interaction (RERI), attributable proportion of interaction (API), and synergy index (SI), were used to analyze the interaction.

Results

Of 30,398 participants, 11,544 (37.98%) participants had CVD and 18,854 (62.02%) did not. Except for gender, the differences were significant between CVD and non-CVD participants in all variables (all P<0.001). Depressive symptoms [odds ratio (OR)=1.73; 95% confidence intervals (CI):1.57–1.91] and sleep disorders (OR=1.76; 95% CI:1.65–1.88) were associated with an increased risk of CVD after adjusting all confounders. Patients with both depressive symptoms and sleep disorders (OR=2.64; 95% CI:2.32–3.00) had a higher risk of CVD than those without. There may be a synergistic interaction between depression and sleep disorders on the CVD occurrence (SI=1.763; 95% CI:1.299–2.394), and the proportion of CVD caused by this interaction was 26.9% (API=0.269; 95% CI:0.148–0.389). In addition, only moderate depressive symptoms may interact with sleep disorders in the occurrence of CVD.

Conclusion

There may be a synergistic interaction between depressive symptoms and sleep disorders, and the synergistic interaction may increase the occurrence of CVD.

The Impact of the COVID-19 Pandemic on Avoidance of Health Care, Symptom Severity, and Mental Well-Being in Patients With Coronary Artery Disease

The COVID-19 pandemic affected regular health care for patients with chronic diseases. However, the impact of the pandemic on primary care for patients with coronary artery disease (CAD) who are enrolled in a structured disease management program (DMP) in Germany is not clear. We investigated whether the pandemic affected primary care and health outcomes of DMP-CAD patients (n = 750) by using a questionnaire assessing patients' utilization of medical care, CAD symptoms, as well as health behavior and mental health since March 2020. We found that out of concern about getting infected with COVID-19, 9.1% of the patients did not consult a medical practitioner despite having CAD symptoms. Perceived own influence on infection risk was lower and anxiety was higher in these patients compared to symptomatic CAD patients who consulted a physician. Among the patients who reported chest pain lasting longer than 30 min, one third did not consult a medical practitioner subsequently. These patients were generally more worried about COVID-19. Patients with at least one worsening CAD symptom (chest pain, dyspnea, perspiration, or nausea without apparent reason) since the pandemic showed more depressive symptoms, higher anxiety scores, and were less likely to consult a doctor despite having CAD symptoms out of fear of infection. Our results provide evidence that the majority of patients received sufficient medical care during the COVID-19 pandemic in Germany. However, one in ten patients could be considered particularly at risk for medical undersupply and adverse health outcomes. The perceived infection risk with COVID-19 might have facilitated the decision not to consult a medical doctor.

Intravenous ketamine for depression: A clinical discussion reconsidering best practices in acute hypertension management

Ketamine is a versatile medication with an emerging role for the treatment of numerous psychiatric conditions, including treatment resistant depression. Current psychiatry guidelines for its intravenous administration to treat depression recommend regular blood pressure monitoring and an aggressive approach to potential transient hypertensive episodes induced by ketamine infusions. While this approach is aimed at ensuring patient safety, it should be updated to align with best practice guidelines in the management of hypertension. This review defines and summarizes the currently recommended approach to the hypertensive emergency, the asymptomatic hypertensive urgency, and discusses their relevance to intravenous ketamine therapy. With an updated protocol informed by these best practice guidelines, ketamine treatment for depression may be more accessible to facilitate psychiatric treatment.

Prospective increases in depression symptoms and markers of inflammation increase coronary heart disease risk - The Whitehall II cohort study

OBJECTIVE

Stress, inflammation, and depression are associated to coronary heart disease (CHD). However, how these constructs collectively contribute to CHD incidence is not well understood. For the first time, this study explored the concurrent relationship between workplace stress, depression symptomology and levels of low-grade inflammation with future CHD incidence.

METHODS

Data from the 5-year intervals at phase 5, 7, and 9 of the Whitehall II study (N = 8348, M_age = 56) provided measures of workplace stress, depression symptomology, inflammation (interleukin-6, C-reactive protein, fibrinogen), and CHD incidence. The proposed stress-inflammation-depression-CHD pathway was assessed with a longitudinal design incorporating a structural equation model (SEM) that measured if changes in stress, depression, and inflammation between phase 5 to phase 7 predicted first-time CHD events between phases 7 and 9.

RESULTS

The SEM empirically supported this proposed pathway and demonstrated excellent model fit, χ (72) = 3582.959, p < .001, CFI = 0.896, RMSEA = 0.076 (CI₉₀ = 0.074, 0.079), while depression symptoms mediated the association between workplace stress and CHD incidence, B = 0.003 (CI₉₀ = 0.001, 0.004). Further, survival analysis indicated that individuals with higher mean scores (across phases) of depression symptoms or fibrinogen levels were more likely to experience a first time CHD event.

CONCLUSIONS

Increases in depression symptoms and fibrinogen levels may be good indicators of future CHD morbidity among older employees. Future research is encouraged to monitor negative affective states and the potential use of biobehavioural options to reduce depression and inflammation that may mitigate CHD risk.

Mental depression: Relation to different disease status, newer treatments and its association with COVID-19 pandemic (Review)

The present study aimed to review major depression, including its types, epidemiology, association with different diseases status and treatments, as well as its correlation with the current COVID-19 pandemic. Mental depression is a common disorder that affects most individuals at one time or another. During depression, there are changes in mood and behavior, accompanied by feelings of defeat, hopelessness, or even suicidal thoughts. Depression has a direct or indirect relation with a number of other diseases including Alzheimer's disease, stroke, epilepsy, diabetes, cardiovascular disease and cancer. In addition, antidepressant drugs have several side effects including sedation, increased weight, indigestion, sexual dysfunction, or a decrease in blood pressure. Stopping medication may cause a relapse of the symptoms of depression and pose a risk of attempted suicide. The pandemic of COVID-19 has affected the mental health of individuals, including patients, individuals contacting patients and medical staff with a number of mental disorders that may adversely affect the immune ability of their bodies. Some of the drugs currently included in the protocols for treating COVID-19 may negatively affect the mental health of patients. Evidence accumulated over the years indicates that serotonin (5HT) deficiencies and norepinephrine (NE) in the brain can lead to mental depression. Drugs that increase levels of NE and 5HT are commonly used in the treatment of depression. The common reason for mood disorders, including mania and bipolar disease are not clearly understood. It is assumed that hyperactivity in specific parts of the brain and excessive activity of neurotransmitters may be involved. Early diagnosis and developing new treatment strategies are essential for the prevention of the severe consequences of depression. In addition, extensive research should be directed towards the investigation of the mental health disturbances occurring during and/or after COVID-19 infection. This may lead to the incorporation of a suitable antidepressant into the current treatment protocols.

Does inflammation mediate the effects of depression on heart disease? That may depend on the symptoms

Preparation of this manuscript was supported in part by grant number R01HL089336 from the National Heart, Lung, and Blood Institute of the National Institutes of Health, Bethesda, Maryland USA, Robert M. Carney.

Exploring the use of psychotropic medication in cardiac patients with and without anxiety and its association with 1-year mortality

AIMS

Comorbid psychiatric disorders and the use of psychotropic medication are common among cardiac patients and have been found to increase the risk of mortality. The aims of this study were: (i) to describe the use of psychotropic medication among cardiac patients with and without symptoms of anxiety, (ii) to estimate the association between use of psychotropic medication prior to hospital admission and all-cause, 1-year mortality following discharge, and (iii) to estimate the risk of mortality among users and non-users of psychotropic medication with or without self-reported symptoms of anxiety.

METHODS AND RESULTS

Cardiac patients from the DenHeart survey were included, providing information on self-reported symptoms of anxiety. From national registers, information on the use of psychotropic medication 6 months prior to hospitalization and mortality was obtained. By logistic regression analyses, the association between the use of psychotropic medication, anxiety, and all-cause, 1-year mortality was estimated. The risk of subsequent incident use of psychotropic medication among patients with and without anxiety was furthermore explored. All analyses were fully adjusted. A total of 12 913 patients were included, of whom 18% used psychotropic medication, and 3% died within 1 year. The use of psychotropic medication was found to be associated with increased 1-year all-cause mortality [odds ratio 1.90 (95% confidence interval, 1.46-2.46)]. Patients with symptoms of anxiety were significantly more likely to use psychotropic medication following hospital discharge [2.47 (2.25-2.72)].

CONCLUSION

The use of psychotropic medication was associated with 1-year mortality. Thus, the use of psychotropic medication might explain some of the association between anxiety and mortality; however, the association is probably mainly a reflection of the underlying mental illness, rather than the use of psychotropic medication.

Regional Brain Perfusion Is Associated with Endothelial Dysfunction Markers in Major Depressive Disorder

BACKGROUND

Major depressive disorder (MDD) is an important independent risk factor for cardiovascular disease. Cumulative data suggest that depressive patients exhibit derangement in regional cerebral blood flow (rCBF), although underlying mechanisms remain mostly unknown. Endothelial dysfunction (ED), defined as different forms of abnormal endothelial activity, plays a key role in the pathogenesis of vascular disease. ED is associated with several clinical conditions characterized by high cardiovascular risk. Diverse ED markers have been found in mood disorders.

PURPOSE

To evaluate the association between rCBF and peripheral ED markers in MDD patients, at baseline and after selective serotonin receptor inhibitors (SSRIs) therapy.

PATIENTS AND METHODS

Twenty-seven untreated unipolar MDD patients in their first episode were evaluated with the Hamilton Depression Rating Scale (HAM-D) and brain perfusion SPECT at baseline and after 2 months of SSRIs. Statistical Parametric Mapping (SPM) was employed to evaluate rCBF; circulating endothelial cells (CECs), plasma soluble intercellular adhesion molecule (sICAM), and high-sensitivity C-reactive protein (hsCRP) were used as independent covariates.

RESULTS

Baseline CECs and sICAM were increased in MDD patients compared with matching controls (p = 0.0001) and hsCRP (p = 0.03). HAM-D scores (21 items) and CECs diminished after SSRI therapy in MDD patients (p < 0.0001). There was a significant rCBF decrease, mainly in deep central structures. HAM-D change was associated with rCBF decrease at the left amygdala, right striatum levels, and Brodmann area 25. CEC change was associated with rCBF at deep brain level and sICAM with large rCBF areas at the left caudate and tectum; hsCRP was associated, to a lesser extent, with the left dorsal striatum and mesencephalic tectum.

CONCLUSION

ED markers in patients with MDD are associated with significant changes in rCBF which are features of depression. These findings suggest that systemic damage/activation of the endothelium may contribute to the abnormal rCBF observed in MDD patients.

Affective and Autonomic Reactivity During Parent-Child Interactions in Depressed and Non-Depressed Mothers and Their Adolescent Offspring

Depression presents risks that are profound and intergenerational, yet research on the association of depression with the physiological processes that might be associated with impaired mental and physical health has only recently been contextualized within the family environment. Participants in this multi-method case-control study were 180 mother-adolescent dyads (50% mothers with a history of depression treatment and current depressive symptoms). In order to examine the association between maternal depression and affective and autonomic reactivity amongst these mothers and their adolescent offspring we collected self-reported measures of positive and negative affect, as well as measures of cardiovascular and electrodermal autonomic activity, during mother-adolescent interaction tasks. Findings indicated that depressed mothers and their adolescent offspring exhibited greater self-reported negative affect reactivity during a problem-solving interaction and blunted (i.e., low) sympathetic activity as measured via skin conductance level across both interaction tasks. These effects remained significant after controlling for a range of potential covariates, including medication use, sex, age, adolescents own mental health symptoms, and behavior of the other interactant, along with correcting for multiple comparisons. Findings indicate that depressed mothers and their adolescent offspring both exhibit patterns of affect and physiology during interactions that are different from those of non-depressed mothers and their offspring, including increased negative affect reactivity during negative interactions and blunted sympathetic activity across both positive and negative interactions. These findings have potential implications for understanding the role of family processes in the intergenerational transmission of risk for depressive disorders.

Added burden of major depressive disorder on cardiovascular morbidity and mortality among patients with cardiovascular disease and the modifying effects of antidepressants: A national retrospective cohort study

BACKGROUND

To evaluate the likelihood of a future cardiovascular event (i.e., in-hospital mortality or cardiovascular disease [CVD] complications/interventions) among patients with CVD and major depressive disorder (MDD) compared to those without MDD, and the antidepressant use on future cardiovascular events between the two groups.

METHODS

This is a retrospective cohort with propensity score matching with 8941 patients with CVD and MDD, and 8941 non-MDD patients using data from the Longitudinal Health Insurance Database from 1999 to 2013 in Taiwan. The outcome was in-hospital mortality and the incidence of revascularization (i.e., percutaneous transluminal coronary angioplasty [PTCA] and coronary artery bypass graft surgery [CABG]).

RESULTS

Patients with CVD and MDD were more likely to need revascularization (an adjusted hazard ratio [aHR]: 1.26 and 95% CI: 1.12-1.43) than those without MDD, regardless of whether PTCA (aHR: 1.23 and 95% CI: 1.07-1.40) or CABG (aHR: 1.60 and 95% CI: 1.16-2.21) had occurred. Antidepressant use was associated with a tendency of reduced risk of mortality (aHR: 0.92 and 95% CI: 0.84-1.00). Although the magnitude of aHR ranged from 0.92 to 0.95 with revascularization, they did not reach significant levels.

LIMITATIONS

Some covariates could not be controlled because they were not included in the national register dataset, and the causality is limited in an observational study.

CONCLUSIONS

Patients with CVD with MDD are more likely to experience a cardiovascular complication requiring intervention than CVD patients without MDD. Antidepressant use is associated with reduced in-hospital mortality.

Effect of the Interaction between Depression and Sleep Disorders on the Stroke Occurrence: An Analysis Based on National Health and Nutritional Examination Survey

OBJECTIVE

To investigate the effect of the interaction between depression and sleep disorders on the stroke occurrence based on the data from the National Health and Nutritional Examination Survey (NHANES).

METHODS

Seven cycles of 2-year NHANES data (2005-2018) were analyzed in this study. Univariate analysis was first performed between the stroke and nonstroke patients, and then, multivariate logistic regression models were conducted to analyze the association of depression, sleep disorders, and their interactions with stroke occurrence.

RESULTS

A total of 30473 eligible participants were included in this study, including 1138 (3.73%) with stroke and 29335 (96.27%) with nonstroke. Except sex, the differences were all significant between the stroke and nonstroke patients in baseline information (all P < 0.001). Depression (odds ratio (OR): 2.494, 95% confidence interval (CI): 2.098-2.964), depression severity (moderate, OR: 2.013, 95% CI: 1.612-2.514; moderately severe, OR: 2.598, 95% CI: 1.930-3.496; severe, OR: 5.588, 95% CI: 3.883-8.043), and sleep disorders (OR: 1.677, 95% CI: 1.472-1.910) were presented to be associated with an increased risk of stroke after correcting all the confounders. The logistic regression analysis showed that there was a synergic, additive interaction between depression and sleep disorders on the stroke occurrence, and the proportion of stroke patients caused by this interaction accounted for 27.1% of all the stroke patients.

CONCLUSION

Depression, depression severity, and sleep disorders are all independently associated with a high risk of stroke. The interaction between depression and sleep disorders can synergistically increase the stroke occurrence.

Dependence of Heart Rate Variability Indices on the Mean Heart Rate in Women with Well-Controlled Type 2 Diabetes

Heart rate variability (HRV) is a method used to evaluate the presence of cardiac autonomic neuropathy (CAN) because it is usually attributed to oscillations in cardiac autonomic nerve activity. Recent studies in other pathologies suggest that HRV indices are strongly related to mean heart rate, and this does not depend on autonomic activity only. This study aimed to evaluate the correlation between the mean heart rate and the HRV indices in women patients with well-controlled T2DM and a control group. HRV was evaluated in 19 T2DM women and 44 healthy women during basal supine position and two maneuvers: active standing and rhythmic breathing. Time-domain (SDNN, RMSSD, pNN20) and frequency-domain (LF, HF, LF/HF) indices were obtained. Our results show that meanNN, age, and the maneuvers are the main predictors of most HRV indices, while the diabetic condition was a predictor only for pNN20. Given the known reduced HRV in patients with T2DM, it is clinically important that much of the HRV indices are dependent on heart rate irrespective of the presence of T2DM. Moreover, the multiple regression analyses evidenced the multifactorial etiology of HRV.

Prevalence Estimates, Severity, and Risk Factors of Depressive Symptoms among Coronary Artery Disease Patients after Ten Days of Percutaneous Coronary Intervention

BACKGROUND

Depression and cardiovascular disorders are significant determinants of health that affect the quality of life and life expectations. Despite the high importance of depression screening among Coronary Artery Disease (CAD) patients, the time being to assess and treat it remains controversial.

OBJECTIVES

This study aims to assess the prevalence estimates and severity of depressive symptoms and determine the risk factors associated with developing such symptoms among CAD patients after ten days of Percutaneous Coronary Intervention (PCI).

METHODS

All patients who underwent elective PCI between October 5, 2019, and Mid-March 2020 and diagnosed with CAD were included in this cross-sectional study. CAD was defined as intra-luminal stenosis of ≥ 50% in one or more of the coronary arteries. Depressive symptoms were screened after ten days of the PCI utilizing the patient health questionnaire-9 (PHQ-9) tool. A linear regression model was used to assess the adjusted effects of independent variables on PHQ-9 scores. Electronic medical records, clinical charts, and PCI and echocardiogram reports were reviewed.

RESULTS

Out of 385 CAD patients, a total of 335 were included in this study, with a response rate of 87%. The participants' mean (±SD) age was 57.5±10.7 years, 75.2% were males, 43% were current smokers, and 73.7% had below bachelor's education. The prevalence estimates of patients with moderate to severe depressive symptoms (PHQ-9 ≥10) was 34%, mild depression 45.1%, and normal 20.9%. Female gender, low educational level and diabetes mellitus were found to be the significant independent predictors of depression among our cohort with (t(333) = 3.68, p<0.001); (t(333) = 5.13, p<0.001); and (t(333) = 2.79, p=0.042), respectively.

CONCLUSION

This study suggests a high prevalence of depressive symptoms among CAD patients after ten days of PCI. Approximately one out of three patients with CAD have significant symptoms of depression, which is an alarming finding for clinicians. Moreover, this study demonstrates a lack of sufficient depression recognition and management in similar study settings. Integration of mental health assessment and treatment among patients with CAD as soon as after PCI is recommended for optimal and effective treatment and to obtain the best outcomes.

Differential Effects of the Inactivation of Anterior and Posterior Orbitofrontal Cortex on Affective Responses to Proximal and Distal Threat, and Reward Anticipation in the Common Marmoset

Structural and functional abnormalities of the orbitofrontal cortex (OFC) have been implicated in affective disorders that manifest anxiety-related symptoms. However, research into the functions of primate OFC has predominantly focused on reward-oriented rather than threat-oriented responses. To redress this imbalance, the present study performed a comprehensive analysis of the independent role of 2 distinct subregions of the central OFC (anterior area 11; aOFC and posterior area 13; pOFC) in the processing of distal and proximal threat. Temporary inactivation of both aOFC and pOFC heightened responses to distal threat in the form of an unknown human, but not to proximal threat assessed in a discriminative Pavlovian conditioning task. Inactivation of the aOFC, however, did unexpectedly blunt conditioned threat responses, although the effect was not valence-specific, as conditioned appetitive responses were similarly blunted and appeared restricted to a discriminative version of the task (when both CS⁻ and CS⁺ are present within a session). Inactivation of the pOFC did not affect conditioned responses to either proximal threat or reward and basal cardiovascular activity was unaffected by manipulations of activity in either subregion. The results highlight the contribution of aOFC and pOFC to regulation of responses to more distal uncertain but not proximal, certain threat and reveal their opposing contribution to that of the immediately adjacent medial OFC, area 14.

Vascular sympathetic neurotransmission and its serotonergic regulation are modified by chronic fluoxetine treatment

Given the interconnection between depressive and cardiovascular disorders, we investigated whether antidepressant treatment (fluoxetine) modifies the serotonergic influence on rat vascular noradrenergic outflow. Twelve-week-old male Wistar rats received fluoxetine treatment (10 mg/kg/day; p.o.) for 14 days; then, they were pithed and prepared for sympathetic stimulation. Vasopressor responses were obtained by electrical stimulation of the sympathetic outflow (0.1, 0.5, 1, and 5 Hz) or i.v. noradrenaline (NA; 0.01, 0.05, 0.1, and 0.5 μg/kg). In fluoxetine-treated group, the electrical-induced vasoconstrictions were lower compared to non-treated rats. Intravenous infusion of 5-HT (10 μg/kg/min) inhibited the sympathetically-induced vasoconstrictions. Only 5-CT, 8-OH-DPAT and L-694,247 (5-HT1/7, 5-HT1A and 5-HT1D agonists, respectively) mimicked 5-HT-induced inhibition, while α-methyl-5-HT (5-HT2 agonist) increased the vasopressor responses. The inhibitory effect of 5-HT was: a) no modified by SB269970 (5-HT7 antagonist); b) abolished by WAY-100,635 (5-HT1A antagonist) plus LY310762 (5-HT1D antagonist); and c) potentiated by ritanserin (5-HT2A receptor antagonist). The vasoconstrictions induced by exogenous NA were not modified by 5-CT but were increased by α-methyl-5-HT. Our results suggest that fluoxetine treatment decreases NA release at vascular level and changes 5-HT modulation on rat vascular noradrenergic neurotransmission, inducing sympatho-inhibition via prejunctional 5-HT1A/1D receptors, and sympatho-potentiation via pre and/or postjunctional 5-HT2A receptors.

From Heartbreak to Heart Disease: A Narrative Review on Depression as an Adjunct to Cardiovascular Disease

Patients with cardiovascular disease (CVD) commonly have subclinical depression and are often delayed in their diagnosis. Literature suggests an increased association of depression and adverse cardiovascular events like myocardial infarction and heart failure. Prevalence of depression in developed countries is approximately 16.6%, and it confers higher cardiovascular mortality even after attrition bias and confounding factors are eliminated. Pharmacological and cognitive-behavioral therapy have been extensively studied, and are generally safe and effective in alleviating depressive symptoms in patients with CVD. However, their impact on cardiovascular outcomes is still unclear. Results of randomized controlled trials have shown antidepressants, especially selective serotonin reuptake inhibitors, to be safe and effective for healing a "broken heart." This review outlines the prevalence of depression in patients with CVD, the pathophysiological mechanism causing cardiovascular events with depression, and a link between depression and CVD. There is a wealth of literature explaining the precursor of CVD in depression, and like all chronic diseases, inflammation seems to be the culprit in this case as well.

Exploring real-world evidence to uncover unknown drug benefits and support the discovery of new treatment targets for depressive and bipolar disorders

BACKGROUND

Major depressive and bipolar disorders are associated with impaired quality of life and high economic burden. Although progress has been made in our understanding of the underlying pathophysiology and the development of novel pharmacological treatments, a large unmet need remains for finding effective treatment options. The purpose of this study was to identify potential new mechanisms of actions or treatment targets that could inform future research and development opportunities for major depressive and bipolar disorders.

METHODS

A self-controlled cohort study was conducted to examine associations between 1933 medications and incidence of major depressive and bipolar disorders across four US insurance claims databases. Presence of incident depressive or bipolar disorders were captured for each patient prior to or after drug exposure and incident rate ratios were calculated. Medications that demonstrated ≥50% reduction in risk for both depressive and bipolar disorders within two or more databases were evaluated as potential treatment targets.

RESULTS

Eight medications met our inclusion criteria, which fell into three treatment groups: drugs used in substance use disorders; drugs that affect the cholinergic system; and drugs used for the management of cardiovascular-related conditions.

LIMITATIONS

This study was not designed to confirm a causal association nor inform current clinical practice. Instead, this research and the methods employed intended to be hypothesis generating and help uncover potential treatment pathways that could warrant further investigation.

CONCLUSIONS

Several potential drug targets that could aid further research and discovery into novel treatments for depressive and bipolar disorders were identified.

Effect of depressive symptom and depressive disorder on glaucoma incidence in elderly

Although depression and glaucoma share several common pathophysiology, the risk of glaucoma in patients with depression has not been reported. Thus, we investigated the effect of depressive symptom and depressive disorder on glaucoma incidence. In this nationwide population-based cohort study, all subjects receiving the National Screening Program at the age of 66 during 2009-2014 were included. These subjects were divided into depression group and no depression group based on subjective depressive symptoms and clinically diagnosed depressive disorder and were tracked until 2017 for development of glaucoma. Of the 922,769 subjects included in the study, 191,636 (20.77%) subjects were categorized as depression group. Subjects with depression showed increased hazard of developing glaucoma (adjusted HR = 1.12[95% confidence interval (CI), 1.09-1.15]) than those without depression. The risk of glaucoma increased sequentially from those with no depression to those with subjective depressive symptom (adjusted HR = 1.09[95% CI, 1.06-1.13]), those with clinically diagnosed depressive disorder (adjusted HR = 1.23[95% CI, 1.14-1.32]), and those with both subjective depressive symptom and clinically diagnosed depressive disorder (adjusted HR = 1.36[95% CI, 1.22-1.52]). Our analyses suggest that individuals with depression had a greater risk of developing glaucoma than those without depression. Subjective depressive symptoms and clinically diagnosed depressive disorder independently and synergistically increased the risk of glaucoma incidence.

The impact of sex and gender on heart-brain axis dysfunction: current concepts and novel perspectives

The heart-brain axis (HBA) recapitulates all the circuits that regulate bidirectional flow of communication between heart and brain. Several mechanisms may underlie the interdependent relationship involving heterogeneous tissues at rest and during specific target organ injury such as myocardial infarction, heart failure, arrhythmia, stroke, mood disorders, or dementia. In-depth translational studies of the HBA dysfunction under single-organ injury should include both male and female animals to develop sex- and gender-oriented prevention, diagnosis, and treatment strategies. Indeed, sex and gender are determining factors as females and males exhibit significant differences in terms of susceptibility to risk factors, age of onset, severity of symptoms, and outcome. Despite most studies having focused on the male population, we have conducted a careful appraisal of the literature investigating HBA in females. In particular, we have (i) analyzed sex-related heart and brain illnesses, (ii) recapitulated the most significant studies simultaneously conducted on cardio- and cerebro-vascular systems in female populations, and (iii) hypothesized future perspectives for the development of a gender-based approach to HBA dysfunction. Although sex- and gender-oriented research is at its infancy, the impact of sex on HBA dysfunction is opening unexpected new avenues for managing the health of female subjects exposed to risk of lifestyle multi-organ disease.

Quercetin exerts antidepressant and cardioprotective effects in estrogen receptor α-deficient female mice via BDNF-AKT/ERK1/2 signaling

Brain-derived neurotrophic factor (BDNF) is the potential link between depression and cardiovascular disease and estrogen receptor α (ERα), an estrogen-mediated major regulator, plays an important role in protecting against depression and cardiovascular disease. However, the relationship between BDNF and ERα remains obscure. Herein, quercetin (QUE), a kind of plant flavonoids and existed in many vegetables and fruits, was found to simultaneously reverse ERα-/--induced depression-like and cardiac dysfunction by reducing immobility time in the tail suspension test (TST) and forced swimming test (FST), and decreasing systolic blood pressure and activating the apoptosis-related proteins, BDNF, tropomyosin-related kinase B (TrkB), protein kinase B (AKT), and extracellular regulatory protein kinase (ERK1/2) in the hippocampal and cardiac tissues of female mice. These findings suggested that ERα might be involved in the regulation of BDNF activity, thereby regulating depression-like and cardiovascular responses in female mice, and QUE exerted significant antidepressant and cardioprotective effects, at least in part, through BDNF-TrkB-AKT/ERK1/2 to effectively inhibit ERα-/--induced hippocampal and cardiac dysfunction.

Autonomic Modulation of Cardiac Activity Across Levels of Sleep Depth in Individuals With Depression and Sleep Complaints

OBJECTIVE

We assessed mean heart rate (HR) and HR variability (HRV) across wake, rapid eye movement (REM) sleep, and non-REM (NREM) sleep, and across varying levels of NREM sleep depth in individuals with depression and sleep complaints.

METHODS

Retrospective polysomnographic data were obtained for 25 individuals diagnosed as having depression (84% female; mean age = 33.8 ± 12.2 years) and 31 mentally healthy controls (58.1% female; mean age = 37.2 ± 12.4 years). All were free of psychotropic and cardiovascular medication, cardiovascular disease, and sleep-related breathing disorders. HR and time-domain HRV parameters were computed on 30-second electrocardiography segments and averaged across the night for each stage of sleep and wake.

RESULTS

Compared with the control group, the depression group had higher HR across wake, REM, and all levels of NREM depth (F(1,51) = 6.3, p = .015). Significant group by sleep stage interactions were found for HRV parameters: SD of normal-to-normal intervals (SDNN; F(2.1,107.7) = 4.4, p = .014) and root mean square differences of successive R-R intervals (RMSSD; F(2.2,113.5) = 3.2, p = .041). No significant group difference was found for SDNN or RMSSD during wake (all, p ≥ .32). However, compared with the control group, the depression group had significantly lower SDNN in REM (p = .040) and all NREM stages (all p ≤ .045), and lower RMSSD during NREM 2 (p = .033) and NREM 3 (p = .034).

CONCLUSIONS

This study suggests that the abnormalities in autonomic cardiac regulation associated with depression and sleep problems are more prominent during sleep, especially NREM sleep, than during wake. This may be due to abnormalities in parasympathetic modulation of cardiac activity.

The link of depression, untreated hypertension, and diabetes with mortality in postmenopausal women: A cohort study

OBJECTIVE

To explore the association of depression, as well as untreated hypertension or diabetes with all-cause death in community-based postmenopausal women in Beijing.

METHODS

A cohort of 863 community-based postmenopausal women with no history of cardiovascular heart disease (CHD), stroke, cancer, or dementia was investigated on 20 July-28 September 2009 at baseline. Depression was diagnosed using the 30-item Center for Epidemiologic Studies Depression (CES-D) scale with CES-D ≥ 11. Meanwhile, data on health behavior, physical comorbidity, and social support at baseline were collected. These individuals were followed up from 20 July to 30 August 2014. All-cause mortality and cause of death were surveyed.

RESULTS

After a median follow-up of 4.97 years, 120 subjects died of all-cause. Twenty-four died of stroke, 19 died of myocardial infarction, 21 died of cancer. The others died of aging, infection, and accident. Depression and untreated HP were significantly associated with all-cause mortality in Cox models after full adjustment for all of the potential confounders (Depression HR: 2.16, 95%CI: 1.35-3.46; Untreated hypertension HR: 1.84, 95%CI: 1.12-3.02). However, negative correlation of untreated diabetes on all-cause mortality was observed in this population (HR: 1.36, 95%CI: 0.75-2.49). When depression was co-existing with hypertension/diabetes, the HR for mortality elevated significantly (Depression co-existing with hypertension HR = 3.87, 95% CI: 2.07-7.23; Depression co-existing with diabetes HR = 5.02, 95% CI: 1.5-16.79).

CONCLUSIONS

It is suggested we should take sufficient care of postmenopausal females with depression and control blood pressure and glucose more effectively. Abbreviations: HP: Hypertension; DM: Diabetes; TC: Cholesterol; TG: Triglyceride; BMI: Body-Mass Index; CES-D: Center for Epidemiologic Studies Depression; CDC: Centers for Disease Control and Prevention; HR: Hazard Ratio; CI: Confidence Interval; ADL: Activities of daily living scale.

A sad heart: Depression and favorable cardiovascular health in Brazil

Depression is associated with poor cardiovascular health (CVH) and increased risk of cardiovascular disease in high-income countries. However, it is unclear whether depression, particularly somatic depressive symptoms, may similarly contribute to poor CVH in a different socioeconomic context. Our aim was to investigate the association between depression and CVH in Brazil, a middle-income country. 49,658 participants (≥18 years) from the 2013 National Health Survey-Brazil. Favorable CVH was defined by meeting recommended levels on five CVH components (blood pressure, body mass index, diabetes or hypercholesterolemia status, smoking status). Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9; depressed if score ≥ 10). Two PHQ-9 sub-domain scores (somatic or cognitive symptoms) were also considered. Covariates included age, sex, race, income, education, region of residence, marital status, chronic diseases, diet and physical activity. Depression was associated with a 27% lower odds of having favorable CVH (OR 0.73; 95%CI 0.62-0.86), and the association was stronger among women (OR 0.72; 95%CI 0.60-0.86). Both somatic and cognitive depression symptoms were inversely associated with lower odds of having favorable CVH. In conclusion, depression is associated with lower odds of having favorable CVH in Brazil, and associations are evident across both somatic and cognitive components of depression. Moreover, the relationship was independent of socioeconomic factors, chronic diseases, and was not strongly explained by diet or physical activity. Overall, our findings suggest that the greater odds of having poor CVH among depressed individuals is not unique to high-income countries.

Antidepressants and the Risk of Cardiovascular Events in Elderly Affected by Cardiovascular Disease: A Real-Life Investigation From Italy

PURPOSE

The purpose of this study was to assess the possible relation between use of antidepressant (AD) drugs, that is, tricyclic ADs, selective serotonin reuptake inhibitors (SSRIs), and atypical ADs (AAs), and the risk of hospitalization for cardiovascular (CV) events among older patients with previous CV diseases.

METHODS

A nested case-control study was carried out among patients aged 65 years and older from 5 Italian health care territorial units who were discharged for CV disease during 2008 to 2010. The cohort was composed by 344,747 individuals, and of these, 97,739 (28%) experienced hospital admission for CV events (myocardial infarction, arrhythmia, stroke, heart failure) during follow-up (until 2014) and were included as cases. Up to 5 controls were randomly selected and matched to each. A conditional logistic regression was fitted to estimate the risk of CV events associated with ADs past or current use. A within-patient comparison was performed by the case-crossover design to account the effect of depression.

FINDINGS

Current users of SSRIs and AAs were at increased risk of CV events with odds ratios of 1.25 (95% confidence interval, 1.21-1.29) and 1.31 (1.25-1.37), respectively. An increased risk of arrhythmia and stroke was associated with current use of SSRIs and AAs, whereas an increased risk of heart failure was detected with current use of any ADs. The results were confirmed by the case-crossover approach.

IMPLICATIONS

Evidence that AD use is associated with an increased risk of CV events in accordance with specific mechanisms of action among older people with CV disease was added by this study.

Impacts of heart disease, depression and their combination on all-cause mortality in older people: a rural community-based cohort study in China

OBJECTIVE

To assess the impact of heart disease (HD) combined with depression on all-cause mortality in older people living in the community.

DESIGN

A population-based cohort study.

PARTICIPANTS

We examined the data of 1429 participants aged ≥60 years recruited in rural areas in Anhui province, China. Using a standard method of interview, we documented all types of HD diagnosed by doctors and used the validated Geriatric Mental Status-Automated Geriatric Examination for Computer Assisted Taxonomy algorithm to diagnose any depression for each participant at baseline in 2003. The participants were followed up for 8 years to identify vital status.

MEASUREMENTS

We sought to examine all-cause mortality rates among participants with HD only, depression only and then their combination compared with those without these diseases using multivariate adjusted Cox regression models.

RESULTS

385 deaths occurred in the cohort follow-up. Participants with baseline HD (n=91) had a significantly higher mortality (64.9 per 1000 person-years) than those without HD (42.9). In comparison to those without HD and depression, multivariate adjusted HRs for mortality in the groups of participants who had HD only, depression only and both HD and depression were 1.46 (95% CI 0.98 to 2.17), 1.79 (95% CI 1.28 to 2.48) and 2.59 (95% CI 1.12 to 5.98), respectively.

CONCLUSION

Older people with both HD and depression in China had significantly increased all-cause mortality compared with those with HD or depression only, and without either condition. Psychological interventions should be taken into consideration for older people and those with HD living in the community to improve surviving outcome.

Happiness at Your Fingertips: Assessing Mental Health with Smartphone Photoplethysmogram-Based Heart Rate Variability Analysis

Background: Heart rate variability (HRV) provides essential mental health information for clinical diagnosis, telemedicine, preventive medicine, and public health; however, the lack of a convenient detection method limits its potential. Objective: This study aims to investigate the feasibility and credibility of smartphone photoplethysmogram (PPG)-based HRV analysis for mental well-being and health assessment. Methods: Data were collected from 93 students and university employees in Shenzhen, China. Forty-six percent were male, and the average age was 23.71 years (σ = 4.33). An app recorded a 4-min video of their fingertips and converted the frames into five HRV measures, including the root mean square of successive differences (rMSSD), standard deviation of the normal-to-normal (NN) intervals (SDNN), percentage of successive NN intervals differing by ≥50 ms (pNN50), log high-frequency (HF) HRV, and log low-frequency (LF) HRV. Results: The data verify the positive relationship between mental well-being and HRV measures. Participants with higher Satisfaction With Life Scale (SWLS) scores have a higher rMSSD (p = 0.047), SDNN (p = 0.009), log HF (p = 0.02), and log LF (p = 0.003). Participants who suffer from depression have lower log HF (p = 0.048) and log LF (p = 0.02). Participants in the high-anxiety group have lower pNN50 (p = 0.04) and log HF (p = 0.03). Conclusions: The results of this study validate the feasibility of using the smartphone PPG by demonstrating similar results to previous findings. Our data also support the theorized positive link between mental health and HRV.

A Proposed Role for Pro-Inflammatory Cytokines in Damaging Behavior in Pigs

Sickness can change our mood for the worse, leaving us sad, lethargic, grumpy and less socially inclined. This mood change is part of a set of behavioral symptoms called sickness behavior and has features in common with core symptoms of depression. Therefore, the physiological changes induced by immune activation, for example following infection, are in the spotlight for explaining mechanisms behind mental health challenges such as depression. While humans may take a day off and isolate themselves until they feel better, farm animals housed in groups have only limited possibilities for social withdrawal. We suggest that immune activation could be a major factor influencing social interactions in pigs, with outbreaks of damaging behavior such as tail biting as a possible result. The hypothesis presented here is that the effects of several known risk factors for tail biting are mediated by pro-inflammatory cytokines, proteins produced by the immune system, and their effect on neurotransmitter systems. We describe the background for and implications of this hypothesis.

Behavioral and Biochemical Effects of KXS on Postmyocardial Infarction Depression

Background

Depression and coronary heart disease (CHD) often occur together in clinical practice. As a traditional Chinese medicine, Kai-Xin-San (KXS) has been widely used for the treatment of emotion-related disorders. In the present study, we aimed to explore whether KXS had both antidepressive effects and cardioprotective functions in a rat model of myocardial ischemia (MI) with depression.

Methods

A total of 50 SD rats were randomly assigned into five groups as follows: normal control (control group), celiac injection of isopropyl adrenaline (ISO) (MI group), depression (depression group), MI+ depression (model group) and MI+ depression treated with intragastric administration of 370 mg/kg KXS (KXS group). MI was induced by subcutaneous injection of 85 mg/kg ISO. Depression was developed by a 7-week chronic mild stress (CMS) challenge. Behavioral test was conducted before and during the experiment. Echocardiography and biochemical analysis were carried out after 7 weeks of CMS challenge.

Results

After 7 weeks of experiment, depression-like behaviors were observed in all the groups except for control and KXS groups, and KXS treatment dramatically increased open-field test scores and sucrose consumption (P < 0.01 vs. model group). Echocardiography and biochemical analysis showed that KXS treatment could improve levels of ejection fraction (EF) and fractional shortening (FS), which were reduced by depression and ISO challenge. Meanwhile, KXS treatment significantly decreased the levels of creation kinase MB (CK-MB) and lactate dehydrogenase (LDH), which were increased in the model group. The activities of superoxide dismutase (SOD), glutathione peroxidase (GSH-PX), catalase (CAT) were increased, while the malondialdehyde (MDA) activity was significantly decreased in the KXS group. Moreover, KXS treatment reduced the levels of C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in myocardial tissue compared with the model group.

Conclusions

KXS had antidepressant-like activity and offered cardioprotective effects against ISO-induced myocardial infarction with depression.

Ventromedial prefrontal area 14 provides opposing regulation of threat and reward-elicited responses in the common marmoset

The ventromedial prefrontal cortex (vmPFC) is a key brain structure implicated in mood and anxiety disorders, based primarily on evidence from correlational neuroimaging studies. Composed of a number of brain regions with distinct architecture and connectivity, dissecting its functional heterogeneity will provide key insights into the symptomatology of these disorders. Focusing on area 14, lying on the medial and orbital surfaces of the gyrus rectus, this study addresses a key question of causality. Do changes in area 14 activity induce changes in threat- and reward-elicited responses within the nonhuman primate, the common marmoset, similar to that seen in mood and anxiety disorders? Area 14 overactivation was found to induce heightened responsivity to uncertain, low-imminence threat while blunting cardiovascular and behavioral anticipatory arousal to high-value food reward. Conversely, inactivation enhanced the arousal to high-value reward cues while dampening the acquisition of cardiovascular and behavioral responses to a Pavlovian threat cue. Basal cardiovascular activity, including heart rate variability and sympathovagal balance, which are dysfunctional in mood and anxiety disorders, are insensitive to alterations in area 14 activity as is the extinction of conditioned threat responses. The distinct pattern of dysregulation compared to neighboring region area 25 highlights the heterogeneity of function within vmPFC and reveals how the effects of area 14 overactivation on positive and negative reactivity mirror symptoms of anhedonia and anxiety that are so often comorbid in mood disorders.

Risk factors for the COVID-19 severity and its correlation with viral shedding: A retrospective cohort study

Coronavirus disease 2019 (COVID‐19) have become a pandemic in the world. This study is aim to explore risk factors for COVID‐19 severity in the early stage and the correlation between the viral shedding and COVID‐19 severity. We included inpatient with laboratory confirmed COVID‐19 who had been discharged by 9 March 2020. The medical record data and dynamic change of biochemical indicators in‐hospital were compared between common and severe patients. Eighty patients were included in this study. Multivariable regression demonstrated increasing odds of severity associated with the duration of fever (odds ratio [OR], 1.42; 95% confidence interval [CI], 1.10‐1.82, per day increase; P = .007), C‐reactive protein (CRP) (OR, 1.26; 95% CI, 1.04‐1.52; P = .02), and PO₂ < 80 mm Hg (28.07, 95% CI, 1.50‐524.12; P = .026) on admission. We found severe acute respiratory syndrome coronavirus 2 viral RNA could be long‐term presence in respiratory tract and fecal sample, up to 43 and 46 days, respectively. However, the duration of viral shedding have no correlation with the COVID‐19 severity. The duration of fever, elevated CRP and PO₂ < 80 mm Hg on admission were associated with the COVID‐19 severity in the early stage and there is no correlation between the viral shedding and COVID‐19 severity.

In this study, we found that the duration of fever, elevated CRP and PO2 < 80 mmHg on admission were associated with the COVID‐19 severity in the early stage and there is no correlation between the viral shedding and COVID‐19 severity.

An attempt to explain the bidirectional association between ischaemic heart disease, stroke and depression: a cohort and meta-analytic approach

BACKGROUND

Depression and cardiovascular diseases (CVDs) are common diseases and associated in a bidirectional manner.

AIMS

To examine whether a bidirectional association between CVD and depression could be explained by shared risk factors, misclassification of disease measures or non-response.

METHOD

A total of 10 population-based cohorts including 93 076 men and women (mean age 54.4 years, s.d. = 9.2) and an additional 10 510 men (mean age 51.2 years, s.d. = 0.3) were followed for subsequent depression, ischaemic heart disease (IHD) and stroke in the Danish National Patient Registry from health examinations between 1982 and 2015 and until end of follow-up in 2017-2018. Exposures were physicians' diagnoses of IHD, stroke, depression or self-reported chest pain, depression, use of antidepressant medication and the Major Depression Inventory at the time of study entry in the Metropolit study. Associations were analysed using Cox proportional hazard regression with disease as time-dependent variables.

RESULTS

IHD and stroke were associated with subsequent depression (hazard ratio (HR) for IHD: 1.79, 95% CI 1.43-2.23 and HR for stroke: 2.62, 95% CI 2.09-3.29) and the associations were present in both men and women. Adjustment for the shared risk factors socioeconomic status, lifestyle, body mass index, statin use and serum lipids did not change the risk estimates. Furthermore, depression was associated with higher risk of subsequent IHD (HR = 1.63, 95% CI 1.36-1.95) and stroke (HR = 1.94, 95% CI 1.63-2.30). The associations were also present when the analyses were based on self-reported disease measures or restricted to include non-responders.

CONCLUSIONS

The bidirectional association between CVD and depression was not explained by shared risk factors, misclassification or non-response.

The State of Our Understanding of the Pathophysiology and Optimal Treatment of Depression: Glass Half Full or Half Empty?

Major depressive disorder is a remarkably common and often severe psychiatric disorder associated with high levels of morbidity and mortality. Patients with major depression are prone to several comorbid psychiatric conditions, including posttraumatic stress disorder, anxiety disorders, obsessive-compulsive disorder, and substance use disorders, and medical conditions, including cardiovascular disease, diabetes, stroke, cancer, which, coupled with the risk of suicide, result in a shortened life expectancy. The goal of this review is to provide an overview of our current understanding of major depression, from pathophysiology to treatment. In spite of decades of research, relatively little is known about its pathogenesis, other than that risk is largely defined by a combination of ill-defined genetic and environmental factors. Although we know that female sex, a history of childhood maltreatment, and family history as well as more recent stressors are risk factors, precisely how these environmental influences interact with genetic vulnerability remains obscure. In recent years, considerable advances have been made in beginning to understand the genetic substrates that underlie disease vulnerability, and the interaction of genes, early-life adversity, and the epigenome in influencing gene expression is now being intensively studied. The role of inflammation and other immune system dysfunction in the pathogenesis of major depression is also being intensively investigated. Brain imaging studies have provided a firmer understanding of the circuitry involved in major depression, providing potential new therapeutic targets. Despite a broad armamentarium for major depression, including antidepressants, evidence-based psychotherapies, nonpharmacological somatic treatments, and a host of augmentation strategies, a sizable percentage of patients remain nonresponsive or poorly responsive to available treatments. Investigational agents with novel mechanisms of action are under active study. Personalized medicine in psychiatry provides the hope of escape from the current standard trial-and-error approach to treatment, moving to a more refined method that augurs a new era for patients and clinicians alike.

Guidelines for wrist-worn consumer wearable assessment of heart rate in biobehavioral research

Researchers have increasingly begun to use consumer wearables or wrist-worn smartwatches and fitness monitors for measurement of cardiovascular psychophysiological processes related to mental and physical health outcomes. These devices have strong appeal because they allow for continuous, scalable, unobtrusive, and ecologically valid data collection of cardiac activity in "big data" studies. However, replicability and reproducibility may be hampered moving forward due to the lack of standardization of data collection and processing procedures, and inconsistent reporting of technological factors (e.g., device type, firmware versions, and sampling rate), biobehavioral variables (e.g., body mass index, wrist dominance and circumference), and participant demographic characteristics, such as skin tone, that may influence heart rate measurement. These limitations introduce unnecessary noise into measurement, which can cloud interpretation and generalizability of findings. This paper provides a brief overview of research using commercial wearable devices to measure heart rate, reviews literature on device accuracy, and outlines the challenges that non-standardized reporting pose for the field. We also discuss study design, technological, biobehavioral, and demographic factors that can impact the accuracy of the passive sensing of heart rate measurements, and provide guidelines and corresponding checklist handouts for future study data collection and design, data cleaning and processing, analysis, and reporting that may help ameliorate some of these barriers and inconsistencies in the literature.

An Active Inference Approach to Interoceptive Psychopathology

Interoception refers to the process by which the nervous system senses and integrates signals originating from within the body, providing a momentary mapping of the body's internal landscape and its relationship to the outside world. Active inference is based on the premise that afferent sensory input to the brain is constantly shaped and modified by prior expectations. In this review we propose that interoceptive psychopathology results from two primary interoceptive dysfunctions: First, individuals have abnormally strong expectations of the situations that elicit bodily change (i.e., hyperprecise priors), and second, they have great difficulty adjusting these expectations when the environment changes (i.e., context rigidity). Here we discuss how these dysfunctions potentially manifest in mental illness and how interventions aimed at altering interoceptive processing can help the brain create a more realistic model of its internal state.

Connecting Social, Clinical, and Home Care Services for Persons with Serious Illness in the Community

The medical, psychological, cognitive, and social needs of older adults with serious illness are best met by coordinated and team-based services and support. These services are best provided in a seamless care model anchored by integrated biopsychosocial assessments focused on what matters to older adults and their social determinants of health; individualized care plans with shared goals; care provision and management; and quality measurement with continuous improvement. This model requires (1) racially and ethnically diverse healthcare professionals, including mental health and direct service workers, with training in aging and team collaboration; (2) an integrated network of community-based organizations (CBOs) providing in-home services; (3) an electronic communication platform that spans the system of providers and organizations with skilled technology staff; and (4) payment models that incentivize team-based care across the continuum of services, including CBOs, with adequate salaries and academic loan forgiveness to recruit and retain high-quality team members. Assuring that this model is effective requires ongoing quality assurance measures that include not only quality of care and utilization data to demonstrate cost offsets of service integration, but also quality of life for both the older adults and the family members caring for them. Although this may seem a lofty ideal in comparison with our current fragmented system, we review models that provide the key elements effectively and cost efficiently. We then propose an Essential Care Model that defines best practice in meeting the needs of older adults with serious illness and their families. J Am Geriatr Soc 67:S412-S418, 2019.

Acute coronary syndrome-associated depression: Getting to the heart of the data

OBJECTIVES

We sought to identify and consider methodological issues that may have limited or confounded investigations into links between depression and acute coronary syndrome (ACS) events.

METHODS

We reviewed salient research studies to identify such issues.

RESULTS

Against previous conclusions, we found that lifetime depression is unlikely to have any primary ACS impact, while we clarify that 'incident depression' (depression commencing at variable periods around the time of the ACS event) appears to confer a greater risk than non-incident depression. As the time periods of incident depressions are likely to have quite differing causes, evaluating any consolidated risk period appears unwise. It remains unclear whether it is 'depression' that provides the risk for ACS events or a higher order factor. Variable use of depression measures and failure to evaluate depressive sub-types have further limited clarification. The response by ACS patients to antidepressant medication appears limited, and it remains to be determined whether exposure to an antidepressant might be a contributing factor. Finally, studies may have focused on an excessively refined association, and neglected to recognise that depression is associated with a wide range of vascular events, suggesting that a broader conceptual model may be required.

LIMITATIONS

The authors have considered only a limited set of studies in preparing this review, with the critique relying at times on subjective interpretation.

CONCLUSIONS

After decades of research pursuing links between depression and ACS events explanatory links remain obscure, presumably reflecting a range of methodological issues that we have discussed in this paper .