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Barra de la Tremblaye P, Plamondon H. Alterations in the corticotropin-releasing hormone (CRH) neurocircuitry: Insights into post stroke functional impairments. Front Neuroendocrinol 2016; 42:53-75. [PMID: 27455847 DOI: 10.1016/j.yfrne.2016.07.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 07/04/2016] [Accepted: 07/06/2016] [Indexed: 10/21/2022]
Abstract
Although it is well accepted that changes in the regulation of the hypothalamic-pituitary adrenal (HPA) axis may increase susceptibility to affective disorders in the general population, this link has been less examined in stroke patients. Yet, the bidirectional association between depression and cardiovascular disease is strong, and stress increases vulnerability to stroke. Corticotropin-releasing hormone (CRH) is the central stress hormone of the HPA axis pathway and acts by binding to CRH receptors (CRHR) 1 and 2, which are located in several stress-related brain regions. Evidence from clinical and animal studies suggests a role for CRH in the neurobiological basis of depression and ischemic brain injury. Given its importance in the regulation of the neuroendocrine, autonomic, and behavioral correlates of adaptation and maladaptation to stress, CRH is likely associated in the pathophysiology of post stroke emotional impairments. The goals of this review article are to examine the clinical and experimental data describing (1) that CRH regulates the molecular signaling brain circuit underlying anxiety- and depression-like behaviors, (2) the influence of CRH and other stress markers in the pathophysiology of post stroke emotional and cognitive impairments, and (3) context and site specific interactions of CRH and BDNF as a basis for the development of novel therapeutic targets. This review addresses how the production and release of the neuropeptide CRH within the various regions of the mesocorticolimbic system influences emotional and cognitive behaviors with a look into its role in psychiatric disorders post stroke.
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Affiliation(s)
- P Barra de la Tremblaye
- School of Psychology, Behavioral Neuroscience Program, University of Ottawa, 136 Jean-Jacques Lussier, Vanier Building, Ottawa, Ontario K1N 6N5, Canada
| | - H Plamondon
- School of Psychology, Behavioral Neuroscience Program, University of Ottawa, 136 Jean-Jacques Lussier, Vanier Building, Ottawa, Ontario K1N 6N5, Canada.
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Norlund F, Olsson EMG, Burell G, Wallin E, Held C. Treatment of depression and anxiety with internet-based cognitive behavior therapy in patients with a recent myocardial infarction (U-CARE Heart): study protocol for a randomized controlled trial. Trials 2015; 16:154. [PMID: 25873137 PMCID: PMC4404081 DOI: 10.1186/s13063-015-0689-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 03/26/2015] [Indexed: 12/20/2022] Open
Abstract
Background Major depression and depressive symptoms are common in patients with a recent myocardial infarction (MI), and depression is associated with adverse cardiovascular outcomes. Anxiety post-MI is less studied, but occurs commonly in patients with heart disease, and is also considered a risk factor for recurrence of cardiac events. Cognitive behavior therapy (CBT) is an established therapy for depression and anxiety disorders. To the best of our knowledge, there have not been any studies to determine if internet-based CBT (iCBT) can reduce the symptoms of depression and anxiety in patients with a recent MI. The main aim of the U-CARE Heart trial is to evaluate an iCBT intervention for patients with a recent MI. Methods/design This is a randomized, controlled, prospective study with a multicenter design. A total of 500 participants will be randomized at a 1:1 ratio, around two months after an acute MI, to either iCBT or to a control group. Both groups will receive an optimal standard of care according to guidelines. The intervention consists of a self-help program delivered via the internet with individual online support from a psychologist. Treatment duration is 14 weeks. The primary outcome is change in patients’ self-rated anxiety and depression symptoms from baseline to end of treatment. An internal pilot study was conducted indicating sufficient levels of study acceptability and engagement in treatment. Discussion The present study is designed to evaluate an iCBT intervention targeting symptoms of depression and anxiety in a post-MI population. If effective, iCBT has several advantages, and will potentially be implemented as an easily accessible treatment option added to modern standard of care. Trial registration This trial was registered with Clinicaltrials.gov (identifier: NCT01504191) on 19 December 2011.
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Affiliation(s)
- Fredrika Norlund
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, Uppsala, SE-751 22, Sweden.
| | - Erik M G Olsson
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, Uppsala, SE-751 22, Sweden.
| | - Gunilla Burell
- Department of Public Health and Caring Sciences, Uppsala University, Box 564, Uppsala, SE-751 22, Sweden.
| | - Emma Wallin
- Department of Psychology, Uppsala University, Box 562 S-75122, Uppsala, Sweden.
| | - Claes Held
- Department of Medical Sciences, Cardiology, Uppsala Clinical Research Center Uppsala University, Dag Hammarskjölds väg 14B, S-752 37, Uppsala, Sweden.
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Tully PJ, Baumeister H. Collaborative care for the treatment of comorbid depression and coronary heart disease: a systematic review and meta-analysis protocol. Syst Rev 2014; 3:127. [PMID: 25351999 PMCID: PMC4214823 DOI: 10.1186/2046-4053-3-127] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 10/20/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Depression and coronary heart disease (CHD) are frequently comorbid and portend higher morbidity, mortality and poorer quality of life. Prior systematic reviews of depression treatment randomized controlled trials (RCTs) in the population with CHD have not assessed the efficacy of collaborative care. This systematic review aims to bring together the contemporary research on the effectiveness of collaborative care interventions for depression in comorbid CHD populations. METHODS/DESIGN Electronic databases (Cochrane Central Register of Controlled Trials MEDLINE, EMBASE, PsycINFO and CINAHL) will be searched using a sensitive search strategy exploding the topics CHD, depression and RCT. Full text inspection and bibliography searching will be conducted, and authors of included studies will be contacted to identify unpublished studies. Eligibility criteria are: population, depression comorbid with CHD; intervention, RCT of collaborative care defined as a coordinated model of care involving multidisciplinary health care providers, including: (a) primary physician and at least one other health professional (e.g. nurse, psychiatrist, psychologist), (b) a structured patient management plan that delivers either pharmacological or non-pharmacological intervention, (c) scheduled patient follow-up and (d) enhanced inter-professional communication between the multiprofessional team; comparison, either usual care, enhanced usual care, wait-list control group or no further treatment; and outcome, major adverse cardiac events (MACE), standardized measure of depression, anxiety, quality of life, cost-effectiveness. Screening, data extraction and risk of bias assessment will be undertaken by two reviewers with disagreements resolved through discussion. Meta-analytic methods will be used to synthesize the data collected relating to the outcomes. DISCUSSION This review will evaluate the effectiveness and cost-effectiveness of collaborative care for depression in populations primarily with CHD. The results will facilitate integration of evidence-based practice for this precarious population. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42014013653.
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Affiliation(s)
- Phillip J Tully
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, Freiburg 79085, Germany
- Freemasons Foundation Centre for Men’s Health, Discipline of Medicine, School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Harald Baumeister
- Department of Rehabilitation Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr. 41, Freiburg 79085, Germany
- Medical Psychology and Medical Sociology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Ismail B, Aboul-Fotouh S, Mansour AA, Shehata HH, Salman MI, Ibrahim EA, Hassan OA, Abdel-tawab AM. Behavioural, metabolic, and endothelial effects of the TNF-α suppressor thalidomide on rats subjected to chronic mild stress and fed an atherogenic diet. Can J Physiol Pharmacol 2014; 92:375-85. [DOI: 10.1139/cjpp-2013-0446] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
There is accumulating evidence suggesting that depression is a risk factor for cardiovascular diseases. This study aimed to examine the hypothesis that the proinflammatory cytokine TNF-α would partially explain the link between depression and atherosclerotic endothelial changes. Rats were distributed among 6 groups: (i) control group; (ii) group subjected to chronic mild stress (CMS); (iii) group fed a cholesterol–cholic acid–thiouracil (CCT diet); and (iv) CMS group fed the CCT diet and treated with the vehicle for 8 weeks. The last 2 groups were subjected to CMS–CCT and received thalidomide (THAL) or imipramine (IMIP). Rats were assessed behaviorally (sucrose preference, open field, and forced-swimming tests). TNF-α protein was assessed from the serum, aorta, and liver. Aortic TNF-α gene expression (assessed using RT–PCR), serum lipid profile, and insulin levels were measured. Endothelial function was assessed in isolated aortic rings. The THAL and IMIP groups showed ameliorated CMS–CCT-related behavioral changes. CMS–CCT-induced metabolic and endothelial dysfunctions were improved in the THAL group but were worsened in the IMIP group. RT–PCR showed a significant reduction of aortic TNF-α mRNA expression in the THAL and IMIP treatment groups. These data paralleled the findings for aortic immunohistochemistry. The THAL group, but not the IMIP group, showed improved CMS–CCT-induced changes in the vascular reactivity of the aortic rings. Thus, TNF-α provides a target link between depression, metabolic syndrome, and endothelial dysfunction. This could open a new therapeutic approach to address the comorbidities of depression.
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Affiliation(s)
- Basma Ismail
- Department of Pharmacology, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, Egypt
- Cardiac PET Centre, University of Ottawa Heart Institute, Ottawa, ON K1Y 4W7, Canada
| | - Sawsan Aboul-Fotouh
- Department of Pharmacology, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, Egypt
- Clinical Pharmacology Unit, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Amal A. Mansour
- Department of Medical Biochemistry, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, Egypt
| | - Hanan H. Shehata
- Department of Medical Biochemistry, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, Egypt
| | - Manal I. Salman
- Department of Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Eman A. Ibrahim
- Department of Pathology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Olfat A. Hassan
- Department of Pharmacology, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, Egypt
| | - Ahmed M. Abdel-tawab
- Department of Pharmacology, Faculty of Medicine, Ain Shams University, Abbassia, Cairo, Egypt
- Clinical Pharmacology Unit, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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De Fazio P, Caroleo M, Rizza P, Cerminara G, De Serio D, Indolfi C, Segura-García C. Specific personality traits and coping styles predict affective symptoms in early post acute coronary syndrome inpatients. Int J Psychiatry Med 2013; 44:119-32. [PMID: 23413659 DOI: 10.2190/pm.44.2.c] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Affective symptoms have adverse effects in hospital and long-term cardiac outcomes of post Acute Coronary Syndrome (ACS) patients. This study aims to identify personality traits and maladaptive coping strategies that could predict affective symptoms in early post-ACS patients. METHODS Seventy patients undergoing revascularization procedures were examined within a week after their admission by means of the Hospital Anxiety-Depression Scale. Personality was analyzed through the Type D Personality Scale and the Coping Inventory for Stressful Situation. Multiple logistic regression analysis was used to determine independent predictors of anxiety and depressed mood. RESULTS A high rate of depressive and anxious symptoms was found and 76% of patients resulted Type D personality. Depression was associated with b-blocker therapy, Type D personality, and specific coping strategies. Unmarried status, low education, unstable angina, Type D personality, emotion, and avoidance oriented coping independently predicted anxiety. CONCLUSION These findings underlie the importance of assessment for Type D personality and coping strategies that could be useful to identify post-ACS patients at higher risk for affective symptoms. Using these brief instruments, as sensitive screening measures, we investigated the prevalence of depressive and anxiety symptoms in patients with ACS, we identified personality traits and coping strategies used to manage stress and estimated independent predictors of affectivity disorders after ACS.
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Wozniak G, Toska A, Saridi M, Mouzas O. Serotonin reuptake inhibitor antidepressants (SSRIs) against atherosclerosis. Med Sci Monit 2011; 17:RA205-14. [PMID: 21873959 PMCID: PMC3560505 DOI: 10.12659/msm.881924] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Selective serotonin reuptake inhibitors (SSRIs) are a class of drug widely used for treatment of mood disorders, including depression and cardiovascular disease. A search for related articles in the PubMed database was attempted. It covered studies, reports, reviews and editorials of the last 5 years. Pro-inflammatory cytokines, such as TNF-α, IL-1 and IL-6, stimulate central serotonin (5-HT) neurotransmission and are over-expressed in depression, which has been linked with hypothalamic-pituitary-adrenal axis (HPA) hyperactivity. They have also been implicated in the pathogenesis and progression of other stress-induced disorders, like myocardial infarction (MI) and coronary heart disease (CHD), as they seem to modulate cardiovascular function by a variety of mechanisms. Biological mechanisms like these may explain the link between depression and CHD. There are a variety of environmental factors as well as genetic factors that might influence the pharmacogenetics of antidepressant drugs. New generation selective serotonin reuptake inhibitor antidepressants (SSRIs) causing a reduced cardiovascular morbidity and mortality may be related to serotonin platelet abnormalities in depressed patients that are effectively treated by SSRIs. SSRIs such as fluoxetine, paroxetine, sertraline and citalopram are not only considered to be free from the cardiotoxicity of their predecessors but also to function as safe and efficacious agents against depression, platelet activation, atherosclerosis and development and prognosis of coronary heart disease. However, there is a need for more studies in order to establish the exact biochemical mechanisms that are responsible for these diseases and the immunoregulatory effects of chronic use of SSRI medications.
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Affiliation(s)
- Greta Wozniak
- Medical School, University of Thessaly, Larissa, Greece.
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Brink E, Karlson BW, Hallberg LRM. Health experiences of first-time myocardial infarction: Factors influencing women's and men's health-related quality of life after five months. PSYCHOL HEALTH MED 2010. [DOI: 10.1080/13548500120101522] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Gesundheitsbezogene Lebensqualität, Angst und Depression vor und nach einer aortokoronaren Bypass-Operation. Wien Med Wochenschr 2010; 160:44-53. [DOI: 10.1007/s10354-009-0722-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Santos M, Kövari E, Hof PR, Gold G, Bouras C, Giannakopoulos P. The impact of vascular burden on late-life depression. ACTA ACUST UNITED AC 2009; 62:19-32. [PMID: 19744522 DOI: 10.1016/j.brainresrev.2009.08.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2008] [Revised: 08/19/2009] [Accepted: 08/27/2009] [Indexed: 02/07/2023]
Abstract
Small vessel pathology and microvascular lesions are no longer considered as minor players in the fields of cognitive impairment and mood regulation. Although frequently found in cognitively intact elders, both neuroimaging and neuropathological data revealed the negative impact on cognitive performances of their presence within neocortical association areas, thalamus and basal ganglia. Unlike cognition, the relationship between these lesions and mood dysregulation is still a matter of intense debate. Early studies focusing on the role of macroinfarct location in the occurrence of post-stroke depression (PSD) led to conflicting data. Later on, the concept of vascular depression proposed a deleterious effect of subcortical lacunes and deep white matter demyelination on mood regulation in elders who experienced the first depressive episode. More recently, the chronic accumulation of lacunes in thalamus, basal ganglia and deep white matter has been considered as a strong correlate of PSD. We provide here a critical overview of neuroimaging and neuropathological sets of evidence regarding the affective repercussions of vascular burden in the aging brain and discuss their conceptual and methodological limitations. Based on these observations, we propose that the accumulation of small vascular and microvascular lesions constitutes a common neuropathological platform for both cognitive decline and depressive episodes in old age.
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Affiliation(s)
- Micaela Santos
- Department of Psychiatry, University Hospitals and Faculty of Medicine of Geneva, Belle-Idée, Switzerland
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10
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Abstract
Depression and cognitive impairment are both common conditions in old age, and frequently occur together. However, accurate figures of the co-occurrence are not available. The inter-relationship between the two clinical entities is still complex and not well understood. Clearly depression can be a psychological reaction to cognitive decline, and thus may also appear as an early symptom in dementing individuals. However, recent data suggest that depression, and in particularly late-life depression, can also be a risk factor for Alzheimer's disease (AD). The relationship between the two clinical entities should be seen in view of observations of white matter changes both in AD and in depression. Since these white matter changes are thought to frequently reflect vascular changes, the concept of "vascular depression" has been advanced. Vascular changes in the brain occur commonly in demented individuals and conversely depression is frequent co-occurrence in vascular disease. Additionally neurotransmitter loss may occur in both, particularly monoaminergic disturbances which is characteristic of depression but may occur also in AD. The same is true for hippocampal atrophy, which is characteristic of AD but has also been described in depression. Here we review the complex relationships between dementia and depression and suggest that excessive release of corticosteroids may have a neurotoxic effects.
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Affiliation(s)
- Amos D Korczyn
- Tel-Aviv University Medical School, Sieratzki Chair of Neurology, Ramat-Aviv 69978, Israel.
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11
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Miller G, Chen E, Cole SW. Health psychology: developing biologically plausible models linking the social world and physical health. Annu Rev Psychol 2009; 60:501-24. [PMID: 19035829 DOI: 10.1146/annurev.psych.60.110707.163551] [Citation(s) in RCA: 414] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Research over the past several decades has documented psychosocial influences on the development and progression of several major medical illnesses. The field is now increasingly focused on identifying the biological and behavioral mechanisms underlying these effects. This review takes stock of the knowledge accumulated in the biological arena to date and highlights conceptual and methodological approaches that have proven especially productive. It emphasizes the value of a disease-centered approach that "reverse engineers" adverse health outcomes into their specific biological determinants and then identifies psychologically modulated neuroendocrine and immunologic dynamics that modulate those pathological processes at the cellular and molecular levels.
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Affiliation(s)
- Gregory Miller
- Department of Psychology, University of British Columbia, Vancouver, V6T 1Z4, British Columbia, Canada.
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Grippo AJ, Johnson AK. Stress, depression and cardiovascular dysregulation: a review of neurobiological mechanisms and the integration of research from preclinical disease models. Stress 2009; 12:1-21. [PMID: 19116888 PMCID: PMC2613299 DOI: 10.1080/10253890802046281] [Citation(s) in RCA: 272] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Bidirectional associations between mood disorders and cardiovascular diseases are extensively documented. However, the precise physiological and biochemical mechanisms that underlie such relationships are not well understood. This review focuses on the neurobiological processes and mediators that are common to both mood and cardiovascular disorders. The discussion places an emphasis on the role of exogenous stressors in addition to: (a) neuroendocrine and neurohumoral changes involving dysfunction of the hypothalamic-pituitary-adrenal axis and the activation of the renin-angiotensin-aldosterone system, (b) immune alterations including activation of pro-inflammatory cytokines, (c) autonomic and cardiovascular dysregulation including increased sympathetic drive, withdrawal of parasympathetic tone, cardiac rate and rhythm disturbances, and altered baroreceptor reflex function, (d) central neurotransmitter system dysfunction involving the dopamine, norepinephrine and serotonin systems, and (e) behavioral changes including fatigue and physical inactivity. The review also discusses experimental investigations using preclinical disease models to elucidate the neurobiological mechanisms underlying the link between mood disorders and cardiovascular disease. These include: (a) the chronic mild stress model of depression, (b) a model of congestive heart failure, (c) a model of cardiovascular deconditioning, (d) pharmacological manipulations of body fluid and sodium balance, and (e) pharmacological manipulations of the central serotonergic system. In combination with an extensive human research literature, the investigation of mechanisms underlying mood and cardiovascular regulation using animal models will enhance understanding the association between depression and cardiovascular disease. This will ultimately promote the development of better treatments and interventions for individuals with co-morbid psychological and somatic pathologies.
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Affiliation(s)
- Angela J Grippo
- Department of Psychiatry and Brain Body Center, University of Illinois at Chicago, Chicago, IL 60612, USA.
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Detweiler-Bedell JB, Friedman MA, Leventhal H, Miller IW, Leventhal EA. Integrating co-morbid depression and chronic physical disease management: identifying and resolving failures in self-regulation. Clin Psychol Rev 2008; 28:1426-46. [PMID: 18848740 PMCID: PMC2669084 DOI: 10.1016/j.cpr.2008.09.002] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2006] [Revised: 08/15/2008] [Accepted: 09/02/2008] [Indexed: 11/22/2022]
Abstract
Research suggests that treatments for depression among individuals with chronic physical disease do not improve disease outcomes significantly, and chronic disease management programs do not necessarily improve mood. For individuals experiencing co-morbid depression and chronic physical disease, demands on the self-regulation system are compounded, leading to a rapid depletion of self-regulatory resources. Because disease and depression management are not integrated, patients lack the understanding needed to prioritize self-regulatory goals in a way that makes disease and depression management synergistic. A framework in which the management of co-morbidity is considered alongside the management of either condition alone offers benefits to researchers and practitioners and may help improve clinical outcomes.
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Grippo AJ. Mechanisms underlying altered mood and cardiovascular dysfunction: the value of neurobiological and behavioral research with animal models. Neurosci Biobehav Rev 2008; 33:171-80. [PMID: 18703084 DOI: 10.1016/j.neubiorev.2008.07.004] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2008] [Revised: 06/14/2008] [Accepted: 07/21/2008] [Indexed: 12/13/2022]
Abstract
A bidirectional association between mood disorders and cardiovascular diseases has been described in humans, yet the precise neurobiological mechanisms that underlie this association are not fully understood. This article is focused on neurobiological processes and mediators in mood and cardiovascular disorders, with an emphasis on common mechanisms including stressor reactivity, neuroendocrine and neurohumoral changes, immune alterations, autonomic and cardiovascular dysregulation, and central neurotransmitter and neuropeptide dysfunction. A discussion of the utility of experimental investigations with rodent models, including those in rats and prairie voles (Microtus ochrogaster), is presented. Specific studies using these models are reviewed, focusing on the analysis of behavioral, physiological and neural mechanisms underlying depressive disorders and cardiovascular disease. Considered in combination with studies using human samples, the investigation of mechanisms underlying depressive behaviors and cardiovascular regulation using animal models will enhance our understanding of the association of depression and cardiovascular disease, and will promote the development of improved interventions for individuals with these detrimental disorders.
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Affiliation(s)
- Angela J Grippo
- Department of Psychology, Northern Illinois University, Psychology-Computer Science Building Room 357, DeKalb, IL 60115, USA.
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15
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Peck MD, Ai AL. Evidence-based interventions for health conditions. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2008; 50 Suppl 1:11-12. [PMID: 18924385 DOI: 10.1080/01634370802137777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Rothenbacher D, Hahmann H, Wüsten B, Koenig W, Brenner H. Symptoms of anxiety and depression in patients with stable coronary heart disease: prognostic value and consideration of pathogenetic links. ACTA ACUST UNITED AC 2007; 14:547-54. [PMID: 17667646 DOI: 10.1097/hjr.0b013e3280142a02] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We evaluated the association of symptoms of anxiety and depression with fatal and non-fatal cardiovascular disease events among patients with coronary heart disease and considered several potential underlying pathogenetic links. DESIGN This was a prospective cohort study. METHODS In this study, including coronary heart disease patients undergoing an in-patient rehabilitation program, symptoms of anxiety and depression were evaluated with the Hospital Anxiety and Depression Scale (HADS). Fatal and non-fatal cardiovascular disease events were determined during a 3-year follow-up. RESULTS Of the 1052 patients with CHD 16.1% showed a borderline and 8.3% a manifest anxiety symptoms score, whereas 11.8 and 5.9% showed a borderline and manifest depressive symptoms score, respectively. During the 3-year follow-up fatal and non-fatal cardiovascular disease events were observed in 73 (6.9%) patients. After adjustment for covariates, patients having manifest anxiety symptoms had a statistically significant hazard ratio (HR) of 2.32 [95% confidence interval (CI) 1.14-4.74] for a cardiovascular disease event, and patients with depressive symptoms had an HR of 1.47 (95% CI 0.62-3.51) compared to other patients. In a model considering anxiety and depressive symptom scores simultaneously, the hazard ratio for a cardiovascular disease event associated with anxiety symptoms increased to 3.31 (95% CI 1.32-8.27), whereas the hazard ratio associated with depressive symptoms decreased (HR 0.62; 95% CI 0.20-1.87). We found a positive association of increased anxiety scores with body mass index and systolic blood pressure. CONCLUSIONS The study suggests an important role especially for symptoms of anxiety for long-term prognosis of patients with known coronary heart disease. It furthermore suggests that several pathogenetic links may partly explain the increased risk.
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Affiliation(s)
- Dietrich Rothenbacher
- Division of Clinical Epidemiology and Aging Research, The German Cancer Research Center, Heidelberg, Germany.
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Krannich JHA, Weyers P, Lueger S, Herzog M, Bohrer T, Elert O. Presence of depression and anxiety before and after coronary artery bypass graft surgery and their relationship to age. BMC Psychiatry 2007; 7:47. [PMID: 17850655 PMCID: PMC2034548 DOI: 10.1186/1471-244x-7-47] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2006] [Accepted: 09/12/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Scientific literature on depression and anxiety in patients with coronary heart disease (CHD) consistently reports data of elevated anxiety and depression scores indicating clinically relevant quantities of these psychopathological conditions. Depression is considered to be a risk factor for the development of CHD and deteriorates the outcome after cardiac rehabilitation efforts. The aim of our study was to evaluate the presence of clinically relevant anxiety and depression in patients before and after coronary artery bypass grafting (CABG). Additionally we evaluated their relationship to age because of the increasing number of elderly patients undergoing CABG surgery. METHODS One hundred and forty-two consecutive patients who underwent CABG in our hospital were asked to fill in the "Hospital Anxiety and Depression Scale - German Version (HADS)" to measure depression and anxiety scores two days before and ten days after CABG surgery. Differences between these pre- and post-surgical scores were then calculated as means for changes, and the amount of elevated scores were appraised. In order to investigate the relationship between age and anxiety and depression, respectively, Spearman correlations between age and the difference scores were calculated. In addition, ANOVA procedures with the factor "age group" and McNemar tests were calculated. Therefore the sample was divided into four equally sized age groups. RESULTS 25.8% of the patients were clinically depressed before and 17.5% after surgery; 34.0% of the patients were clinically anxious before and 24.7% after surgery. This overall change is not significant. We found a significant negative correlation between age and the difference between the two time points for anxiety (Spearman rho = -.218; p = 0.03), but not for depression (Spearman rho = -.128; p = 0.21). ANOVA and McNemar-Tests revealed that anxiety scores and the number of patients high in anxiety declined statistically meaningful only in the youngest patient group. Such a relationship could not be found for depression. CONCLUSION Our data show a relationship between age and anxiety. Younger patients are more anxious before CABG surgery than older ones and show a decline in symptoms while elderly patients show hardly any change.
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Affiliation(s)
| | - Peter Weyers
- Department of Clinical Psychology, University of Wuerzburg, Germany
| | | | - Michael Herzog
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Greifswald, Germany
| | - Thomas Bohrer
- Department of Cardio-Thoracic Surgery, University of Wuerzburg, Germany
| | - Olaf Elert
- Department of Cardio-Thoracic Surgery, University of Wuerzburg, Germany
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Abstract
Cognitive dysfunction accompanying depression has been considered to be separate from dementia and, thus, has been termed pseudodementia, with the presumption that it will disappear once the depressed mood remits. On the other hand, depression accompanied by dementia fulfills the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition definition of mood disorder due to its general condition. However, lately it has been documented that depression may precede dementia and, in particular, Alzheimer’s disease. Dementia and depression display many common biological features, such as white matter changes in the brain, reduction of hippocampal volume, changes in the serotonergic and noradrenergic systems and abnormalities in the hypothalamic–pituitary–adrenal axis. These changes point to extensive system damage, beginning with dysthymia and depression episodes, which, over the years, lead to the development of dementia, possibly through hypersecretion of corticosteroids that may be toxic to the hippocampus.
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Affiliation(s)
- Ilan Halperin
- Tel-Aviv Sourasky Medical Center, Department of Neurology, Memory Clinic, Tel-Aviv, 64239, Israel
| | - Amos D Korczyn
- Tel-Aviv Univeristy Medical School, Sieratzki Chair of Neurology, Tel-Aviv, Ramat-Aviv, 69978, Israel
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Yanagita M, Willcox BJ, Masaki KH, Chen R, He Q, Rodriguez BL, Ueshima H, Curb JD. Disability and depression: investigating a complex relation using physical performance measures. Am J Geriatr Psychiatry 2006; 14:1060-8. [PMID: 17138811 DOI: 10.1097/01.jgp.0000224364.70515.12] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to examine the relation of physical performance measures with depressive symptoms in older men. METHOD A cross-sectional, multivariate comparison of several measures of upper- and lower-extremity performance and their relation with depressive symptoms was performed in 2,856 older Japanese American men, aged 71-93 years, who participated in the fourth examination of the Honolulu Heart Program. Depressive symptoms were measured using an 11-item version of Center for Epidemiologic Studies Depression (CES-D) Scale. A score of at least 9 (from a maximum score of 33) is considered clinically significant. Timed functional performance tests, including walking and repeated chair stands, were used to assess lower-extremity performance; handgrip strength was used as an indicator of upper-extremity performance. RESULTS Two hundred eighty-three participants (9.9%) had a score of 9 or greater on the 11-question CES-D Scale and were considered to be at high risk for depression. Time to walk 10 feet and time to complete five chair stands were significantly longer in those with depressive symptoms, whereas handgrip strength was significantly lower. Only the association of gait speed (time to walk 10 feet) and depressive symptoms remained significant when all physical performance measures were simultaneously included in a multivariate analysis. CONCLUSION These results demonstrate physical performance measures, particularly gait speed, may be important potential correlates of depression in community-dwelling older men.
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20
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Strik JJMH, Honig A, Klinkenberg E, Dijkstra J, Jolles J. Cognitive performance following fluoxetine treatment in depressed patients post myocardial infarction. Acta Neuropsychiatr 2006; 18:1-6. [PMID: 26991975 DOI: 10.1111/j.0924-2708.2006.00110.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND As depression is a considerable risk factor for an unfavourable course of myocardial infarction (MI), antidepressant treatment of post-MI depression and, inherent to MI status, polypharmacy has become an important issue. OBJECTIVE The present study is the first to evaluate cognitive side effects of fluoxetine, as part of a placebo-controlled double-blind trial, in patients with post-first MI depression. METHODS Cognitive performance of 54 depressed patients post first-MI, treated with fluoxetine or placebo was compared. Cognitive performance was tested before and after 9 weeks of treatment using the Visual Verbal Learning Test, Concept Shifting Task, Stroop Colour-Word Test and Letter-Digit-Substitution Test. RESULTS The median number of cardiovascular drugs taken by MI patients was 4.9. There were no differences between the fluoxetine and the placebo group on cognitive performance. CONCLUSION In sum, there were no negative side effects of fluoxetine compared with placebo on cognition in depressed MI patients, simultaneously treated with cardiac drugs.
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Affiliation(s)
- Jacqueline J M H Strik
- 1Department of Psychiatry, University Hospital Maastricht/University of Maastricht, The Netherlands
| | - Adriaan Honig
- 1Department of Psychiatry, University Hospital Maastricht/University of Maastricht, The Netherlands
| | - Edwin Klinkenberg
- 1Department of Psychiatry, University Hospital Maastricht/University of Maastricht, The Netherlands
| | - Jeanette Dijkstra
- 1Department of Psychiatry, University Hospital Maastricht/University of Maastricht, The Netherlands
| | - Jelle Jolles
- 1Department of Psychiatry, University Hospital Maastricht/University of Maastricht, The Netherlands
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21
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Wise FM, Harris DW, Carter LM. Validation of the Cardiac Depression Scale in a cardiac rehabilitation population. J Psychosom Res 2006; 60:177-83. [PMID: 16439271 DOI: 10.1016/j.jpsychores.2005.07.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2003] [Accepted: 07/13/2005] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The current study was undertaken to provide further evidence supporting the reliability and validity of the Cardiac Depression Scale (CDS) in a population of cardiovascular patients. METHODS The CDS was administered to 627 consecutive ambulatory adult cardiac patients attending an outpatient Cardiac Rehabilitation program, and a subgroup also completed the Geriatric Depression Scale--Short Form (GDS-SF). RESULTS Factor analysis revealed six subscales accounting for 62% of scale variance. The CDS demonstrated high internal consistency (Cronbach's alpha=.92) and correlation coefficient with the GDS-SF of .77. Receiver operating characteristic curves suggested a CDS cutoff score of 100 to detect more severe depression, and 90 to detect mild to moderate depression. CONCLUSION These findings encourage the continued use and evaluation of the CDS for measuring symptoms of depressive affect in cardiac patients.
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Sebregts EHWJ, Falger PRJ, Appels A, Kester ADM, Bär FWHM. Psychological effects of a short behavior modification program in patients with acute myocardial infarction or coronary artery bypass grafting. A randomized controlled trial. J Psychosom Res 2005; 58:417-24. [PMID: 16026656 DOI: 10.1016/j.jpsychores.2004.02.021] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2002] [Accepted: 02/03/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The effects of a short intervention on behavioral risk factor modification in patients with coronary artery disease (CAD) on Type A behavior, vital exhaustion, and depression were studied in a randomized controlled trial. METHODS Acute myocardial infarction patients or patients who underwent coronary artery bypass grafting (CABG) were randomly assigned to an 8-week multiple risk modification group program (n = 94) or to a control group (n = 90) that received usual care with standard physical exercise training. Patients were assessed before intervention, directly after intervention, and at 9-month follow-up. RESULTS The intervention was effective in reducing hostility and total Type A behavior at postintervention (P = .01) and at 9-month follow-up (P = .03). The intervention had no overall impact on vital exhaustion and depression, measured by the Beck Depression Inventory (BDI), whereas we unexpectedly found that the percentage of patients with major depression was reduced in the control group but not in the intervention group. CONCLUSION The results indicate that a short behavioral intervention for coronary patients can result in relatively large and persistent reductions in cognitive aspects of Type A behavior and hostility, in particular. In view of the unwanted findings on the diagnosis of depression, however, we do not unequivocally advise the intervention to the general population of AMI and CABG patients.
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Affiliation(s)
- Ellen H W J Sebregts
- Department of Medical, Clinical and Experimental Psychology, Maastricht University, The Netherlands.
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Tata LJ, West J, Smith C, Farrington P, Card T, Smeeth L, Hubbard R. General population based study of the impact of tricyclic and selective serotonin reuptake inhibitor antidepressants on the risk of acute myocardial infarction. Heart 2005; 91:465-71. [PMID: 15772201 PMCID: PMC1768803 DOI: 10.1136/hrt.2004.037457] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To investigate the impact of tricyclic antidepressants (TCAs) and selective serotonin reuptake inhibitors (SSRIs) on the risk of first acute myocardial infarction (MI). DESIGN Case-control analysis and a self controlled case series. SETTING 644 general practices throughout England, Scotland, Wales, and Northern Ireland. PATIENTS Over 60,000 cases of MI and 360,000 age, sex, and practice matched controls randomly selected from the UK General Practice Research Database. MAIN OUTCOME MEASURES Matched odds ratios and incidence rate ratios estimating whether there is an acute or prolonged increased risk of MI after exposure to TCA and SSRI drugs and individual drugs within these families. RESULTS Case-control analysis found an initial increased risk of MI after TCA exposure (for example, at 1-7 days after the first dothiepin prescription: odds ratio (OR) 1.90, 95% confidence interval (CI) 1.15 to 3.14) or SSRI exposure (for example, at 1-7 days after first fluoxetine prescription: OR 2.59, 95% CI 1.44 to 4.66). In the self controlled analysis the equivalent risk estimates were an incidence rate ratio of 1.43, 95% CI 0.92 to 2.22 for dothiepin and an incidence rate ratio of 1.66, 95% CI 1.01 to 2.71 for fluoxetine. CONCLUSIONS Antidepressant prescriptions are associated with an increased risk of MI. The size of these effects is similar for TCA and SSRI exposures; however, the lack of specificity between types of antidepressants and the lower risks found in the self controlled analysis suggest that these associations are more likely due to factors relating to underlying depression and health services utilisation than to specific adverse drug effects.
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Affiliation(s)
- L J Tata
- Division of Epidemiology and Public Health, Clinical Sciences Building, Hucknall Road, Nottingham NG5 1PB, UK.
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25
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Abstract
Cardiac patients' beliefs about the causes of their illness may influence their receptivity to psychosocial interventions. The purpose of this study was to determine whether depression or anxiety influence patients' attributions about the causes of their heart disease. The primary hypothesis was that depressed or anxious patients are more likely to endorse negative emotions as among the causes of their heart disease than are patients who are not depressed or anxious. Sixty-nine patients with documented ischemic heart disease recruited from an exercise stress testing laboratory completed the Beck Depression and Anxiety Inventories and a heart disease attribution checklist. Univariate analyses confirmed that patients who are depressed or anxious are more likely than other patients to endorse negative emotions as causes of their heart disease. Anxiety but not depression was retained as an independent predictor of negative emotion attributions in a logistic regression analysis. We conclude that mood state influences cardiac patients' beliefs about the causes of their heart disease.
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Affiliation(s)
- Ryan C Day
- Department of Psychology, Washington University, St. Louis, Missouri 63108, USA
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26
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Herrmann-Lingen C. Psychotherapie bei Patienten mit koronarer Herzkrankheit. PSYCHOTHERAPEUT 2005. [DOI: 10.1007/s00278-005-0416-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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27
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Affiliation(s)
- Kenneth E Freedland
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri 63108, USA.
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Bjerkeset O, Nordahl HM, Mykletun A, Holmen J, Dahl AA. Anxiety and depression following myocardial infarction: gender differences in a 5-year prospective study. J Psychosom Res 2005; 58:153-61. [PMID: 15820843 DOI: 10.1016/j.jpsychores.2004.07.011] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2003] [Accepted: 07/19/2004] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of this study was to examine the impact of the first myocardial infarction (MI) and the relative influence of preexisting confounding factors on anxiety and depression in the following 5 years. METHODS A total of 23,693 participants, 35-79 years of age at baseline, attended two population-based prospective studies in 1984-1986 and in 1995-1997. They underwent physical examination and self-reported demographic, lifestyle, psychosocial, and medical health characteristics in both surveys. Outcome measure was the Hospital Anxiety and Depression rating Scale (HADS). RESULTS Five hundred twelve participants suffered their first MI in the last 5 years before follow-up. Women showed an increased risk for both anxiety and depression in the first 2 years post-MI, followed by a significant symptom reduction. In contrast, the risk for depression in men increased after 2 years post-MI. Anxiety and depression, low educational level, obesity, daily smoking, and physical inactivity pre-MI significantly predicted a poor psychiatric outcome at follow-up. CONCLUSION Five-year follow-up after MI revealed gender-specific outcomes of anxiety and depression not previously described.
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Affiliation(s)
- Ottar Bjerkeset
- HUNT Research Centre, Norwegian University of Science and Technology, Trondheim, Norway.
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29
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Abstract
The United States Preventive Services Task Force (USPSTF) recently issued the recommendation that primary care physicians screen adult patients for depression. A policy to screen primary care patients for depression has appeal as a strategy to reduce the personal and societal costs of undiagnosed and untreated depression. Such appeal may be justified if the evidence supports the screening policy in three areas: effectiveness, cost-effectiveness, and feasibility. The USPSTF recommendation leaves many issues in each of these areas unresolved and physicians are left the choice of two important program characteristics: screening instrument and screening interval. We discuss how uncertainties in the screening protocol and treatment process affect whether screening is an effective and cost-effective use of resources with respect to other health interventions. We suggest that targeting screening to groups at a higher risk for depression may lead to a more effective use of health care resources. A screening program may not be feasible even if effectiveness and cost-effectiveness are optimized. We discuss uncertainties in the USPSTF recommendation that affect the feasibility of implementing such a program in physicians' practices.
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Affiliation(s)
- Donna D McAlpine
- Division of Health Services Research and Policy, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA.
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30
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Abstract
The fact that traditional risk factors only account for approximately two thirds of cases of coronary artery disease (CAD) has stimulated increasing interest in the relationship between CAD and psychosocial factors. Five areas--chronic stress, socioeconomic status (SES), personality, depression, and social support--have been most thoroughly examined. There is evidence to support a causal relationship between chronic stress, SES, depression, and social support and development of CAD. In this article, we discuss the epidemiologic evidence linking psychosocial factors and CAD, and review the effects of psychosocial factors on several pathophysiologic mechanisms that have been proposed as potential mediators of CAD. The hypothalamic-pituitary-adrenal axis, hypertension and cardiovascular reactivity, endothelial function, inflammatory markers, platelets, coagulation factors, fibrinogen, lipids, glucose metabolism, and lifestyle factors have all been implicated in this process. Recently, the first intervention trials have been carried out, although with initially disappointing results. Reducing the cardiovascular risk due to these psychosocial factors will be one of the major health care challenges in the future.
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Affiliation(s)
- Philip C Strike
- Psychology Group, Department of Epidemiology and Public Health, University College London, UK.
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31
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Davidson KW, Rieckmann N, Lespérance F. Psychological theories of depression: potential application for the prevention of acute coronary syndrome recurrence. Psychosom Med 2004; 66:165-73. [PMID: 15039500 DOI: 10.1097/01.psy.0000116716.19848.65] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The natural course of elevated depressive symptoms or subthreshold depression in patients with an acute coronary syndrome (ACS) is presented, as is the prognostic impact. Safe and effective psychological treatment options are desirable for subthreshold depression in patients with ACS, should they prove tolerable, efficacious, and cost-effective to cardiologists and their patients. To achieve this long-term goal, we propose focusing on 3 intermediate goals. First, we need to understand which symptoms or patterns of symptoms (eg, fatigue, anhedonia, guilt feelings) are specifically predictive of ACS recurrence. Second, the prevalence of known psychosocial vulnerabilities (proximal causes) of depressive disorders should be assessed in patients with ACS, to understand better the etiology of these symptoms in these patients. Third, randomized controlled trials of vulnerability-related, evidence-based psychological depression interventions in cardiac patients are needed. The ways in which psychological proximal cause theories are relevant--or irrelevant--for both the treatment of depressive symptoms in post-ACS patients and the prevention of ACS recurrence are discussed.
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Affiliation(s)
- Karina W Davidson
- Columbia College of Physicians and Surgeons, New York, NY 10032, USA.
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32
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Strik JJMH, Denollet J, Lousberg R, Honig A. Comparing symptoms of depression and anxiety as predictors of cardiac events and increased health care consumption after myocardial infarction. J Am Coll Cardiol 2004; 42:1801-7. [PMID: 14642691 DOI: 10.1016/j.jacc.2003.07.007] [Citation(s) in RCA: 225] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVES We sought to compare symptoms of depression and anxiety as predictors of incomplete recovery after a first myocardial infarction (MI). BACKGROUND Depressive symptoms have been related to post-MI mortality and health care consumption, but little is known about the effect of anxiety. We wanted to examine the effect of emotional distress on health care consumption and whether depressive symptomatology is a better predictor of prognosis than anxiety. METHODS Subjects were 318 men (mean age 58 years) who completed the depression, anxiety, and hostility scales from the 90-item symptom check list after they survived a first MI. RESULTS After an average follow-up of 3.4 years, there were 25 cardiac events (fatal or non-fatal MI). Symptoms of both depression (hazard ratio [HR] 2.32, 95% confidence interval [CI] 1.04 to 5.18; p = 0.039) and anxiety (HR 3.01, 95% CI 1.20 to 7.60; p = 0.019) were associated with cardiac events, adjusting for age, left ventricular ejection fraction, and use of antidepressants. However, a multivariate analysis including all three negative emotions indicated that symptoms of anxiety (HR 2.79, 95% CI 1.11 to 7.03; p = 0.029) explained away the relationship between depressive symptoms and cardiac events. Regarding health care consumption, anxiety (OR 2.00, 95% CI 1.24 to 3.22; p = 0.005), but not depression/hostility, was a predictor of cardiac rehospitalization and frequent visits at the cardiac outpatient clinic. CONCLUSIONS Symptoms of depression and anxiety were associated with cardiac events. Anxiety was an independent predictor of both cardiac events and increased health care consumption and accounted for the relationship between depressive symptoms and prognosis. Symptoms of anxiety need to be considered in the risk stratification and treatment of post-MI patients.
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Affiliation(s)
- Jacqueline J M H Strik
- Department of Psychiatry, Academic Hospital Maastricht/Maastricht University, Maastricht, Netherlands
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33
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34
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Abstract
A variety of drugs targeted towards the central nervous system are associated with cardiac side effects, some of which are linked with reports of arrhythmia and sudden death. Some psychotropic drugs, particularly tricyclic antidepressants (TCAs) and antipsychotic agents, are correlated with iatrogenic prolongation of the QT interval of the electrocardiogram (ECG). In turn, this is associated with the arrhythmia (TdP). This review discusses the association between psychotropic agents, arrhythmia and sudden death and, focusing on TCAs and antipsychotics, considers their range of cellular actions on the heart; potentially pro-arrhythmic interactions between psychotropic and other medications are also considered. At the cellular level TCAs, such as imipramine and amitriptyline, and antipsychotics, such as thioridazine, are associated with inhibition of potassium channels encoded by In many cases this cellular action correlates with ECG changes and a risk of TdP. However, not all psychotropic agents that inhibit HERG at the cellular level are associated equally with QT prolongation in patients, and the potential for QT prolongation is not always equally correlated with TdP. Differences in risk between classes of psychotropic drugs, and between individual drugs within a class, may result from additional cellular effects of particular agents, which may influence the consequent effects of inhibition of repolarizing potassium current.
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Affiliation(s)
- Harry J Witchel
- Department of Physiology and Cardiovascular Research Laboratories, School of Medical Sciences, University of Bristol, Bristol, United Kingdom.
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35
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Abstract
Psychological depression is shown to be associated with several aspects of coronary artery disease (CAD), including arrhythmias, myocardial infarction, heart failure and sudden death. The physiological mechanisms accounting for this association are unclear. Hypothalamic-pituitary-adrenal dysregulation, diminished heart rate variability, altered blood platelet function and noncompliance with medial treatments have been proposed as mechanisms underlying depression and cardiovascular disease. Recent evidence also suggests that reduced baroreflex sensitivity, impaired immune function, chronic fatigue and the co-morbidity of depression and anxiety may be involved in the relationship between depression and cardiovascular dysregulation. An experimental strategy using animal models for investigating underlying physiological abnormalities in depression is presented. A key to understanding the bidirectional association between depression and heart disease is to determine whether there are common changes in brain systems that are associated with these conditions. Such approaches may hold promise for advancing our understanding of the interaction between this mood disorder and CAD.
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Affiliation(s)
- Angela J Grippo
- Department of Psychology, The University of Iowa, Iowa City 52242-1407, USA
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36
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Abstract
OBJECTIVE To determine if a question about symptoms of depression in a mail survey predicts mortality after adjusting for a large number of covariates. DESIGN National cross-sectional survey of 141,589 enrollees in Medicare, age 65 and older. Analyses used multivariate logistic regression models with death as the outcome. RESULTS Response to a question about sadness or anhedonia was associated with death in 2 years (OR = 1.32; 95% CI = 1.2, 1.4). Results were consistent across age, gender, and presence/absence of known heart disease. Other responses associated with death were older age, male gender, and self-reported cancers, shortness of breath, heart failure, smoking, and other characteristics. Higher education and being married appeared to protect from death. DISCUSSION A single survey question about feelings of sadness or anhedonia is predictive of death in 2 years.
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van den Brink RH, van Melle JP, Honig A, Schene AH, Crijns HJ, Lambert FP, Ormel J. Treatment of depression after myocardial infarction and the effects on cardiac prognosis and quality of life: Rationale and outline of the Myocardial INfarction and Depression-Intervention Trial (MIND-IT). Am Heart J 2002. [DOI: 10.1067/mhj.2002.123580] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Jacobi F, Wittchen HU, Hölting C, Sommer S, Lieb R, Höfler M, Pfister H. Estimating the prevalence of mental and somatic disorders in the community: aims and methods of the German National Health Interview and Examination Survey. Int J Methods Psychiatr Res 2002; 11:1-18. [PMID: 12459800 PMCID: PMC6878553 DOI: 10.1002/mpr.118] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
This paper outlines the principal aims and design of the German National Health Interview and Examination Survey, mental health supplement (GHS-MHS), the first nationwide, epidemiological study of both somatic and mental health in Germany on a representative sample of 4,181 subjects in the community. Both the broader context of the study--in particular its methodological relation to the social and somatic core survey of the German National Health Interview and Examination Survey (GHS-CS)--and the internal methodology of the mental health supplement (GHS-MHS) are presented. The study's strategies and method are derived from a consideration of important theoretical issues arising from epidemiological studies in the field of public health. The main instrument used to assess diagnoses of mental disorders was a standardized diagnostic interview for mental disorders (following DSM-IV (CIDI)) applied by clinically trained interviewers. This diagnostic interview was supplemented by modules on comorbidity, help seeking, treatment and impairment. Somatic health diagnoses were made using an integrated approach including self-report measures, a standardized clinical interview, and laboratory measures. Findings on sampling, response rate, weighting and sample characteristics are presented. Critical issues are discussed, including the scientific objectives that have been achieved by the study. Overall, the GHS core survey and its mental health supplement provide the mental health research community with complex data that allow for high-quality analysis of mental disorders and associations with somatic disorders.
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Affiliation(s)
- Frank Jacobi
- Institute of Clinical Psychology and Psychotherapy, Unit, Technical University of Dresden, Germany.
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40
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Abstract
Poor quality of life assessed singly, using an instrument designed to assess quality of life, or variously, using assessments of job stress, depression, anxiety, hostility, anger, or life events, seems to be predictive of poor cardiovascular health and attendant morbidity and mortality. Since risk factors appear to cluster together, new studies may benefit from concentrating on assessing quality of life and health in multivariate domains, including both psychological and behavioral aspects of life, and validating instruments for use as predictive tools in the future. However, single questions on energy also appear useful as predictors.
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Affiliation(s)
- R Peters
- Epidemiology Research Unit, Care of the Elderly, Imperial College Faculty of Medicine, Hammersmith Campus, Du Cane Road, London W12 0NN, UK.
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Strik JJ, Honig A, Maes M. Depression and myocardial infarction: relationship between heart and mind. Prog Neuropsychopharmacol Biol Psychiatry 2001; 25:879-92. [PMID: 11383983 DOI: 10.1016/s0278-5846(01)00150-6] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
There is a relationship between depression and Myocardial Infarction (MI) as higher levels of depression and severe depression (major vs minor) are associated with higher morbidity and mortality due to cardiac events, which are mainly caused by arrhythmia. Second, severity of MI is not or even inversely related to development of depression. Depression post-MI goes often unrecognized as only 10% of depressed MI patients are diagnosed as such. This underestimation of depression is attributed to its atypical profile, tendency of physicians to interpret depressive symptoms as a transient and 'natural' reaction to a life-threatening event, and the scarce knowledge of risk factors associated with development of post-MI depression. During the first 18 months following MI major depression occurs in 15-30% of patients. Depression should be assessed in an early stage as depression has the highest prevalence in hospital and in the first 6 months post-MI. Risk factors for developing post-MI depression include complications during hospitalization, prescription of benzodiazepines during hospitalisation, previous history of depression, and not being able to stop smoking. Selective Serotonin Reuptake Inhibitors (SSRIs) appear to be first choice treatment in post-MI depression. As yet there is no information on the efficacy and safety of Serotonin and Noradrenalin Reuptake Inhibitors (SNRIs).
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Affiliation(s)
- J J Strik
- Department of Psychiatry, Academic Hospital Maastricht, The Netherlands
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42
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Dalfen AK, Stewart DE. Who develops severe or fatal adverse drug reactions to selective serotonin reuptake inhibitors? CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2001; 46:258-63. [PMID: 11320680 DOI: 10.1177/070674370104600306] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To ascertain the risk factors associated with the development of severe and fatal adverse drug reactions (ADRs) or intentional overdoses by patients on selective serotonin reuptake inhibitors (SSRIs). METHODS We undertook a data analysis of Health Canada's database of Adverse Drug Reactions to SSRIs from 1986 to 1996, as well as a literature review. RESULTS Among the complete ADR reports in the SSRI database, there were no sex differences in occurrences of all ADRs (n = 1011), severe ADRs (n = 295), drug-drug interactions (n = 312), deaths (n = 87), or intentional overdoses (n = 79), when sex differences in prescription practices were considered. There were no differences in ADR rates among different SSRIs. The most common cause of death among patients taking SSRIs was intentional overdose (n = 65, 74.7%). This was reported in 47 (72.3%) women and 18 (27.7%) men. The most common drugs taken with SSRIs in patients who died of intentional overdoses were benzodiazepines, tricyclic antidepressants (TCAs), narcotics, alcohol, and diphenhydramine. Patients who had severe or fatal ADRs were more likely to be taking an SSRI with 2 or more other drugs, including alcohol. Drug combinations that included another CYP-450 drug were especially problematic. A total of 129 cardiovascular ADRs were reported, most of which were severe. These included rhythm disturbances, blood pressure perturbations, and chest pain or angina. Cardiovascular ADRs most often occurred with concomitant drug use of benzodiazepines, TCAs, histamine H2 antagonists, lithium, and calcium channel blockers. There were 3 deaths from malignant neuroleptic syndrome unassociated with intentional overdose. CONCLUSIONS SSRIs are relatively safe when their widespread use is compared with the prevalence of ADRs. SSRIs may, however, be associated with ADRs, and even death, following intentional overdose or when taken with 2 or more other drugs or alcohol (particularly another drug metabolized by CYP-450). Physicians prescribing SSRIs need to consider drug-drug interactions and carefully monitor patients with severe affective disorders, comorbid medical conditions (especially cardiovascular disease), alcohol abuse, or a history of overdosing.
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Abstract
The identification of peripheral markers of psychiatric illness is important if an improvement in the diagnosis and treatment of various diseases with overlapping symptomatology is desired. There are many disorders that not only have overlapping symptomatology, but also have similar biological disturbances. The functional capability of the neurons involved in the disease processes may be at the crux of the underlying pathology. The platelet intracellular calcium response to neurotransmitter stimulation has previously been used as a peripheral marker of psychiatric illness. This review discusses evidence in support of the extended use of the platelet as a peripheral marker. The use of the platelet intracellular calcium response to neurotransmitter stimulation as a state or trait marker in major depression, the specificity and selectivity of this response, and the possible use of the platelet as a peripheral marker in psychotic disorders such as schizophrenia, mania and psychotic depression are shown. Finally, a proposed mechanism for the association between certain psychiatric disorders and cardiovascular disease is discussed. Copyright 2001 John Wiley & Sons, Ltd.
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Affiliation(s)
- Helein Plein
- Department of Experimental and Clinical Pharmacology, Faculty of Health Sciences, University of the Witwaterstrand, 7 York Road, Parktown, Johannesburg 2193, South Africa
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