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Hu Y, Dong X, Zhang T, Ma H, Yang W, Wang Y, Liu P, Chen Y. Kai‑Xin‑San suppresses matrix metalloproteinases and myocardial apoptosis in rats with myocardial infarction and depression. Mol Med Rep 2019; 21:508-516. [PMID: 31746394 DOI: 10.3892/mmr.2019.10807] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/10/2019] [Indexed: 11/06/2022] Open
Abstract
Depression is often triggered by prolonged exposure to psychosocial stressors and associated with coronary heart disease (CHD). Matrix metalloproteinases (MMPs) are involved in the pathogenesis of various emotional and cardiovascular disorders. The purpose of this study was to investigate whether Kai‑Xin‑San (KXS), which may terminate the signaling of MMPs, exerts antidepressant‑like and cardioprotective effects in a myocardial infarction (MI) plus depression rat model. Rats were randomly assigned to five groups: A normal control (control group), a celisc‑injection of isopropyl adrenaline group (ISO group), depression (depression group), an ISO + depression (depression + ISO group), and an ISO + depression group treated with intragastric administration of 1,785 mg/kg KXS (KXS group). Behavioral changes, echocardiography, biochemical index, matrix metalloproteinase (MMP) and apoptosis‑related proteins were assessed. Compared with the depression + ISO group, KXS significantly improved stress‑induced alterations of behavioral parameters and protected the heart by enlarging the left ventricular (LV) fractional shortening (FS) and LV ejection fraction (EF). Moreover, KXS significantly attenuated ISO + depression‑induced MMP‑2 and MMP‑9 expression at the mRNA and protein level and decreased TIMP in the heart compared to the complex model group. Myocardial apoptosis was significantly attenuated by KXS by regulating the Bcl‑2/Bax axis. These results indicated that MI comorbid with depression may damage the MMP balance in the central and peripheral system, and KXS may have a direct anti‑depressive and cardio‑protective effect by regulating the level of MMPs and associated myocardial apoptosis. It is promising to further explore the clinical potential of KXS for the therapy or prevention of MI plus depression comorbidity disease.
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Affiliation(s)
- Yuan Hu
- Department of Clinical Pharmacology, Pharmacy Care Center, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Xianzhe Dong
- Department of Pharmacy, Xuanwu Hospital of Capital Medical University, Beijing 100053, P.R. China
| | - Tianyi Zhang
- Department of Clinical Pharmacology, Pharmacy Care Center, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Hongming Ma
- Department of Clinical Pharmacology, Pharmacy Care Center, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Wenshan Yang
- Department of Clinical Pharmacology, Pharmacy Care Center, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Yichen Wang
- Department of Clinical Pharmacology, Pharmacy Care Center, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Ping Liu
- Department of Clinical Pharmacology, Pharmacy Care Center, Chinese PLA General Hospital, Beijing 100853, P.R. China
| | - Yibang Chen
- Department of Pharmacology and System Therapeutics, Mount Sinai School of Medicine, New York, NY 10029, USA
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Zhang LJ, Liu MY, Rastogi R, Ding JN. Psychocardiological disorder and brain serotonin after comorbid myocardial infarction and depression: an experimental study. Neurol Res 2018; 40:516-523. [PMID: 29577822 DOI: 10.1080/01616412.2018.1455460] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Objectives We investigated whether trimetazidine pretreatment can regulate central and peripheral serotonin (5-HT) in rats of myocardial infarction (MI) combined with depression. Methods Forty rats were randomly assigned to a sham operation group (n = 10) and a disease model group (n = 30). The sham operation group was pretreated with normal saline for 4 weeks. The disease model group was randomly assigned further into a negative control subgroup, a positive control subgroup, and a treatment subgroup - the groups received saline, sertraline, and trimetazidine pretreatment, respectively, for 4 weeks, then the rats were subjected to MI combined with depression. 5-HT concentrations in the serum, platelet lysate, and cerebral cortex lysate were analyzed with ELISA. Results The levels of serum 5-HT and platelet 5-HT were significantly lower in negative control subgroup than the sham operation group (P < 0.05), but there was no significant difference in brain 5-HT (P > 0.05). Compared with the negative control subgroup, the levels of serum 5-HT and platelet 5-HT in the positive control subgroup and treatment subgroup were significantly higher (P < 0.05). The levels of 5-HT in brain of the positive control subgroup and treatment subgroup were significantly lower than those in the negative control subgroup (P < 0.05). Conclusions Trimetazidine pretreatment can increase serum and platelet 5-HT levels in rats with MI and depression and decrease 5-HT levels in brain tissue. This regulatory effect on central and peripheral 5-HT suggests a role for trimetazidine in the treatment of psychocardiological diseases.
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Affiliation(s)
- Li-Jun Zhang
- a Department of Cardiology , Beijing Anzhen Hospital Affiliated to Capital Medical University , Beijing , China
| | - Mei-Yan Liu
- a Department of Cardiology , Beijing Anzhen Hospital Affiliated to Capital Medical University , Beijing , China
| | - Radhika Rastogi
- b Department of Neurosurgery , Wayne State University School of Medicine , Detroit , MI , USA
| | - Jessie N Ding
- b Department of Neurosurgery , Wayne State University School of Medicine , Detroit , MI , USA
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Tolentino JC, Schmidt SL. DSM-5 Criteria and Depression Severity: Implications for Clinical Practice. Front Psychiatry 2018; 9:450. [PMID: 30333763 PMCID: PMC6176119 DOI: 10.3389/fpsyt.2018.00450] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 08/30/2018] [Indexed: 11/15/2022] Open
Abstract
Background: Depression diagnosis requires five or more symptoms (Diagnostic and Statistical Manual of Mental Disorders-DSM-5). One of them must be either Depressed mood or Anhedonia, named main criteria. Although the secondary symptoms can be divided into somatic and non-somatic clusters, the DSM-5 identify depression in all or none fashion. In contrast, depression severity is a continuous variable. Therefore, it is commonly assessed with scales such as the Hamilton Depression Rating Scale (HAMD). Previously, we reported that patients with moderate depression (MD) exhibit greater impairments in cardiac-autonomic modulation than severely depressed (SD) patients. However, clinicians usually do not use scales. Objective: To verify whether the DSM-5 symptoms would be able to discriminate SD from MD and MD from non-depressed (ND) subjects. Material and Methods: Depression was diagnosed based on the Structured Clinical Interview for DSM-5® Disorders. The HAMD evaluated depression severity. In depressed subjects, MD and SD were defined considering the HAMD scores. ND was defined considering both the absence of DSM-5 criteria for depression and the HAMD score. Among 782 outpatients, 46 SD were found. MD and ND subjects were randomly sampled to match the demographic variables of the SD group. Results: Discriminant analysis showed that Depressed Mood was the most reliable symptom to discriminate ND from MD. Anhedonia discriminated SD from MD. Among the secondary DSM-5 criteria, the somatic cluster discriminated ND from MD and the non-somatic cluster SD from MD patients. Discussion: The presence of the somatic cluster in MD may indicate decreased vagal tone and/or increased sympathetic tone, leading to higher cardiovascular risk. As SD is associated with the non-somatic cluster, these patients are at risk of committing suicide. The DSM-5 symptoms exhibited by the patient may help the choice of adequate pharmacological treatment. This would avoid the use of antidepressants that unnecessarily increase cardiac risk in MD. When the symptom cluster suggests SD, the treatment must focus on the prevention of suicide. Conclusions: Depression severity may be inferred based on the DSM-5 criteria. The presence of the Anhedonia main criterium accompanied by non-somatic criteria indicate SD. The Depressive Mood criterium followed by somatic criteria suggest MD.
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Affiliation(s)
- Julio C Tolentino
- Department of Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Sergio L Schmidt
- Department of Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
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Abstract
Depression is the most prevalent psychiatric disorder in transplant recipients and may lead to noncompliance and negative outcomes without psychosocial and pharmacologic interventions. The pharmacologic treatment of depression in this patient population is complicated by complex immunosuppressant drug regimens and multiple potential drug interactions that can adversely affect the newly transplanted organs. This review provides a brief overview of the currently available antidepressant medications and highlights the clinically important features each class of agents in transplant recipients. Newer agents selective serotonin reuptake inhibitors, venlafaxine, bupropion, nefazodone, and mirtazapine are discussed as well as tricyclic antidepressants and monoamine oxidase inhibitors. A brief discussion of St. John's wort and its impact on posttransplant drug therapy is also included.
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Affiliation(s)
- Jiwon Kim
- University of Southern California, School of Pharmacy, Los Angeles, California, USA
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Severity of Depression, Anxious Distress and the Risk of Cardiovascular Disease in a Swedish Population-Based Cohort. PLoS One 2015; 10:e0140742. [PMID: 26469703 PMCID: PMC4607409 DOI: 10.1371/journal.pone.0140742] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 09/30/2015] [Indexed: 12/30/2022] Open
Abstract
Background Depression is known to be associated with cardiovascular diseases (CVD). This population-based cohort study aimed to determine the association between depression of varying severity and risk for CVD and to study the effect of concomitant anxious distress on this association. Methods We utilized data from a longitudinal cohort study of mental health, work and relations among adults (20–64 years), with a total of 10,443 individuals. Depression and anxious distress were assessed using psychiatric rating scales and defined according to DSM-5. Outcomes were register-based and self-reported cardiovascular diseases. Findings Overall increased odds ratios of 1.5 to 2.6 were seen for the different severity levels of depression, with the highest adjusted OR for moderate depression (OR 2.1 (95% CI 1.3, 3.5). Similar odds ratios were seen for sub-groups of CVD: ischemic/hypertensive heart disease and stroke, 2.4 (95% CI 1.4, 3.9) and OR 2.1 (95%CI 1.2, 3.8) respectively. Depression with anxious distress as a specifier of severity showed OR of 2.1 (95% CI 1.5, 2.9) for CVD. Conclusion This study found that severity level of depression seems to be of significance for increased risk of CVD among depressed persons, although not in a dose-response manner which might be obscured due to treatment of depression. Further, we found a higher risk of CVD among depressed individuals with symptoms of anxious distress.
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Hong DH, Li H, Kim HS, Kim HW, Shin SE, Jung WK, Na SH, Choi IW, Firth AL, Park WS, Kim DJ. The Effects of the Selective Serotonin Reuptake Inhibitor Fluvoxamine on Voltage-Dependent K + Channels in Rabbit Coronary Arterial Smooth Muscle Cells. Biol Pharm Bull 2015; 38:1208-13. [DOI: 10.1248/bpb.b15-00207] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Da Hye Hong
- Department of Physiology, Kangwon National University School of Medicine
| | - Hongliang Li
- Department of Physiology, Kangwon National University School of Medicine
| | - Han Sol Kim
- Department of Physiology, Kangwon National University School of Medicine
| | - Hye Won Kim
- Department of Physiology, Kangwon National University School of Medicine
| | - Sung Eun Shin
- Department of Physiology, Kangwon National University School of Medicine
| | - Won-Kyo Jung
- Department of Biomedical Engineering, Center for Marine-Integrated Biomedical Technology (BK21 Plus) Pukyong National University
| | - Sung Hun Na
- Department of Obstetrics and Gynecology, Kangwon National University Hospital, School of Medicine, Kangwon National University
| | - Il-Whan Choi
- Department of Microbiology, Inje University College of Medicine
| | | | - Won Sun Park
- Department of Physiology, Kangwon National University School of Medicine
| | - Dae-Joong Kim
- Department of Anatomy and Cell Biology, Kangwon National University School of Medicine
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Igoumenou A, Alevizopoulos G, Anastasakis A, Stavrakaki E, Toutouzas P, Stefanadis C. Depression in patients with hypertrophic cardiomyopathy: is there any relation with the risk factors for sudden death? HEART ASIA 2012; 4:44-8. [PMID: 27326027 DOI: 10.1136/heartasia-2012-010099] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/16/2012] [Indexed: 11/04/2022]
Abstract
OBJECTIVES The aim of this study was to investigate whether depressive symptoms are related to the risk factors for sudden death in patients with hypertrophic cardiomyopathy (HCM). DESIGN 121 patients diagnosed as having HCM were assessed for depressive symptomatology using the Beck Depression Inventory and the Center for Epidemiological Studies Depression Scale (CES-D) and followed up for a period of 2 years. For the interview, the authors used the Structured Clinical Interview for DSM-III/DSM-III-R. A multidimensional longitudinal study was carried out with both somatic and psychological symptoms and signs taken into consideration. SPSS was used for the statistical analysis. RESULTS (1) Patients with HCM are more depressed than the general population. (2) There is no positive correlation between the occurrence of depressive symptoms and the risk factors for sudden death in patients with HCM. (3) Patients at high risk for sudden death are not more depressed than the others. (4) Time from diagnosis of the cardiac disease is not related to the presence and severity of depressive symptoms. CONCLUSIONS Patients with HCM are more depressed than the general population. The authors suggest that depressive symptoms and risk factors for sudden death in these patients are not related. It is important to screen for mood disorders in this patient population in order to provide an early diagnosis and treatment of the psychiatric disease.
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Affiliation(s)
| | | | - Aris Anastasakis
- Division of Inherited Cardiovascular Disease, Department of Cardiology, University of Athens, Athens, Greece
| | | | - Pavlos Toutouzas
- Division of Inherited Cardiovascular Disease, Department of Cardiology, University of Athens, Athens, Greece
| | - Christodoulos Stefanadis
- Division of Inherited Cardiovascular Disease, Department of Cardiology, University of Athens, Athens, Greece
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Riley AA, McEntee ML, Gerson L, Dennison CR. Depression as a Comorbidity to Diabetes: Implications for Management. J Nurse Pract 2009. [DOI: 10.1016/j.nurpra.2009.03.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Abstract
PURPOSE OF REVIEW Discuss the interplay of depression and ischemic heart disease. Studies demonstrate high prevalence of depression and its negative impact among patients with ischemic heart disease. RECENT FINDINGS Results extend previous findings among men, demonstrating a significant increase in mortality and cardiovascular events among depressed women. Sertraline, citalopram and mitrazapine have been shown to be safe and well tolerated in patients with ischemic heart disease. Sertraline and citalopram have demonstrated efficacy for treating depression in such patients. Mirtazapine did not have significant efficacy on post-myocardial infarction depression. Cognitive-behavioral therapy and interpersonal therapy have not been found to have a significant treatment effect. Treating depression may have an impact on cardiovascular morbidity and mortality, but this has not yet been adequately studied. Studies to date lack sufficient statistical power to fully examine the impact of interventions for depression on cardiovascular outcomes. SUMMARY Cardiologists encounter depression among 25-30% of their patients with ischemic heart disease. Depression is an independent risk factor for poor prognosis among ischemic heart disease patients, at a level comparable to several conventional cardiac risk factors. Adequate treatment of depression may improve the poor prognosis of depressed patients with ischemic heart disease.
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Affiliation(s)
- Sarah Rivelli
- Department of Internal Medicine, Duke University Medical Center, Durham, North Carolina 27710, USA
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Davydov DM, Shapiro D, Cook IA, Goldstein I. Baroreflex mechanisms in major depression. Prog Neuropsychopharmacol Biol Psychiatry 2007; 31:164-77. [PMID: 17011098 DOI: 10.1016/j.pnpbp.2006.08.015] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2006] [Revised: 06/23/2006] [Accepted: 08/23/2006] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent studies have shown that depressive disorder is associated with impaired baroreceptor or baroreflex sensitivity, which is proposed to be a predisposing factor for sudden death in patients with manifest cardiac disease. These studies have not evaluated the afferent and efferent components of the cardiac baroreflex loop or other baroreflex mechanisms that regulate target processes (cardiac metabolism and blood pressure variability) related to the impairment. The objective of this study was to gain more insight into autonomic functioning in depressive disorder to more fully examine the potential basis for increased cardiac mortality. METHODS The subjects were 28 women and men with unipolar major depression who were taking antidepressant medications and who were in partial remission and free of cardiovascular or other serious disease, and 28 healthy control subjects matched for sex, age, and ethnicity. The two samples were compared for negative affective dispositions (anger expression, hostility, defensiveness, anxiety), spontaneous (closed-loop) baroreflex activity, heart rate, heart rate variability, systolic blood pressure, and heart rate-systolic blood pressure double product under resting conditions. RESULTS Depressed patients showed a general disposition to anger suppression coupled with higher hostility and anxiety, and lower defensiveness. The patients showed higher general sympathetic activity (high levels of blood pressure, low-frequency heart rate variability) and lower parasympathetic-related activity (high heart rate and reduced high frequency heart rate variability) with affected cardiac metabolism estimated by the double product. Depressed patients had lower baroreflex sensitivity related to a higher gain of the afferent component of the baroreflex without respective gain adjustment of its efferent component (reflex gain 'de-afferentation'). It was coupled with a compensatory higher number of effective baroreflex reactions (reflex gating 're-afferentation'). Antidepressant agents and depressed mood had additional independent effects on baroreflex sensitivity through the efferent component of the cardiac baroreflex loop. CONCLUSIONS The data indicate that different baroreflex components and mechanisms may be impaired in patients with depression and may contribute to their increased cardiac risk.
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Affiliation(s)
- Dmitry M Davydov
- Department of Neurophysiology, Moscow Research Center of Narcology, 156-3-68 Leninsky pr-t, Moscow 117571, Russia.
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Fossa AA, Gorczyca W, Wisialowski T, Yasgar A, Wang E, Crimin K, Volberg W, Zhou J. Electrical alternans and hemodynamics in the anesthetized guinea pig can discriminate the cardiac safety of antidepressants. J Pharmacol Toxicol Methods 2007; 55:78-85. [PMID: 16678449 DOI: 10.1016/j.vascn.2006.03.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2006] [Accepted: 03/24/2006] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The arrhythmogenic risk of fluoxetine, citalopram, and venlafaxine were evaluated through preclinical assays measuring hERG, blood pressure and electrical alternans over their respective clinical unbound concentration ranges. METHODS Anesthetized guinea pigs were instrumented with jugular and carotid cannulae for drug infusion and blood pressure monitoring respectively; a thoracotomy was performed for placement of a monophasic action potential probe on the left ventricle and for placement of pacing wires on the left ventricular apex. Drugs were infused as a 5-min loading dose immediately followed by a 10-min maintenance dose to achieve clinically relevant plasma concentrations; blood samples were taken at the end of each maintenance dose. Ventricular pacing was performed twice at baseline and at each dose level as follows: 50 preconditioning-beats at S1=220 (or 240) ms immediately followed by 30 test-beats at S2=200 ms. This S1-S2 protocol was repeated for S2=190 to 140 ms. HERG and calcium current measurements were recorded in HEK-293 cells stably expressing hERG potassium currents and freshly isolated guinea pig cardiac myocytes using the whole-cell configuration of the patch clamp technique. RESULTS Physiologically relevant inhibition (IC(20)) of hERG occurred at concentrations 22-fold (fluoxetine), 9-fold (citalopram), and 11-fold (venlafaxine) beyond their respective clinically effective concentration (C(eff)). At the highest achievable levels, fluoxetine (20-fold C(eff)) and citalopram (28-fold C(eff)) significantly decreased heart rate and/or blood pressure as well as increasing electrical alternans by 5 and 18 ms respectively. Venlafaxine increased blood pressure at only 1.3-fold C(eff), but did not increase electrical alternans at the highest achievable dose (3.1-fold C(eff)). DISCUSSION These data suggest that evaluating other dose limiting side effects in relation to a drug's therapeutic range may be crucial for accurate assessment of arrhythmia liability.
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Affiliation(s)
- Anthony A Fossa
- Pfizer Global Research and Development, Groton, CT 06340, USA.
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Chrapko W, Jurasz P, Radomski MW, Archer SL, Newman SC, Baker G, Lara N, Le Mellédo JM. Alteration of decreased plasma NO metabolites and platelet NO synthase activity by paroxetine in depressed patients. Neuropsychopharmacology 2006; 31:1286-93. [PMID: 16319917 DOI: 10.1038/sj.npp.1300961] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Although major depression (MD) and cardiovascular disease (CVD) have been conclusively linked in the literature, the mechanism associating MD and CVD is yet undetermined. The purpose of this paper is to further investigate a potential mechanism involving nitric oxide (NO) and to examine the effect of the selective serotonin reuptake inhibitor paroxetine on NO production by both platelets and the endothelium. In total, 17 subjects with MD and 12 healthy controls (HCs) with no known history of cardiovascular illness completed the study. Paroxetine was administered to both the MD patients and HCs over an 8-week period, and then medication was discontinued. Blood samples were taken at various times throughout paroxetine treatment and after discontinuation. Plasma NO metabolite (NOx) levels were measured by a chemiluminescence method. Platelet endothelial NO synthase (eNOS) activity was examined through the conversion of L-[14C]arginine to L-[(14)C]citrulline. Data were analyzed using t-tests and a linear mixed effects model. Baseline levels of both plasma NOx and platelet NOS activity were significantly lower in subjects with MD compared to HCs. Throughout paroxetine treatment, plasma NOx levels increased in both HCs and MD patients. However, platelet eNOS activity decreased in HCs, while no statistically significant change was evidenced in MD patients. These data suggest that, in MD patients, decreased peripheral production of NO, a potential contributor to increased cardiovascular risk, is modified by administration of the antidepressant paroxetine.
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Affiliation(s)
- Wendy Chrapko
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
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Grippo AJ, Beltz TG, Weiss RM, Johnson AK. The effects of chronic fluoxetine treatment on chronic mild stress-induced cardiovascular changes and anhedonia. Biol Psychiatry 2006; 59:309-16. [PMID: 16154542 DOI: 10.1016/j.biopsych.2005.07.010] [Citation(s) in RCA: 134] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2005] [Revised: 06/21/2005] [Accepted: 07/11/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND Depression has a complex bidirectional association with heart disease. Previously we have shown notable cardiovascular changes in the chronic mild stress (CMS) rodent model of depression. Here we investigated the effects of a serotonin-specific reuptake inhibitor on a behavioral index of depression (anhedonia) and cardiac function in rats exposed to CMS. METHODS Male Sprague-Dawley rats were exposed to either 4 weeks of control conditions or CMS, consisting of unpredictable periods of mild stressors, while being treated concurrently with 4 weeks of daily fluoxetine (10 mg/kg, sc) or vehicle. RESULTS Chronic fluoxetine treatment prevented anhedonia in rats exposed to CMS, versus the CMS group treated with vehicle. However, treatment with fluoxetine in the CMS group only partially prevented specific cardiovascular changes associated with CMS, including elevated resting heart rate (HR), exaggerated pressor and HR responses to air jet stress, reduced cardiac output and stroke volume, and HR exaggerated responses to beta-adrenergic receptor blockade. CONCLUSIONS These findings provide evidence that 4 weeks of fluoxetine treatment can prevent behavioral responses and can partially prevent cardiovascular changes associated with CMS, providing insight into the role of serotonin in the link between depression and cardiovascular dysfunction.
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Affiliation(s)
- Angela J Grippo
- Department of Psychology, Cardiovascular Center, University of Iowa, Iowa City, Iowa 52242-1407, USA
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Jiang W, Davidson JRT. Antidepressant therapy in patients with ischemic heart disease. Am Heart J 2005; 150:871-81. [PMID: 16290952 DOI: 10.1016/j.ahj.2005.01.041] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2004] [Accepted: 01/22/2005] [Indexed: 10/25/2022]
Abstract
Depressive disorders are common in patients with ischemic heart disease and have serious consequences in terms of the risk of further cardiac events and cardiac mortality. Among survivors of acute myocardial infarction, up to one fifth meet diagnostic criteria for major depression, and the presence of major depression carries a >5-fold increased risk for cardiac mortality within 6 months. This article reviews clinical trial data on the cardiac safety profiles of antidepressant agents with the aim of discussing clinical considerations in selecting the most appropriate treatment of comorbid depression in patients with ischemic heart disease. Tricyclic antidepressants are effective against depression but are associated with cardiovascular side effects including orthostatic hypotension, slowed cardiac conduction, antiarrhythmic activity, and increased heart rate. Selective serotonin reuptake inhibitors, by contrast, have benign cardiovascular profiles and are well tolerated in patients with cardiac disease. The safety of dual-acting serotonin and noradrenaline reuptake inhibitors has not been well studied. Intervention with a selective serotonin reuptake inhibitors has the potential to provide the depressed patient with ischemic heart disease relief from their depressive symptoms and may offer a potential improvement in their cardiovascular risk profile.
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Affiliation(s)
- Wei Jiang
- Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
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Yeragani VK, Rao R. Effect of nortriptyline and paroxetine on measures of chaos of heart rate time series in patients with panic disorder. J Psychosom Res 2003; 55:507-13. [PMID: 14642980 DOI: 10.1016/s0022-3999(03)00023-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Tricyclic antidepressants have notable cardiac side effects, and this issue has become important due to the recent reports of increased cardiovascular mortality in patients with depression and anxiety. Several previous studies indicate that serotonin reuptake inhibitors (SRIs) do not appear to have such adverse effects. Apart from the effects of these drugs on routine 12-lead ECG, the effects on beat-to-beat heart rate (HR) and QT interval time series provide more information on the side effects related to cardiac autonomic function. In this study, we evaluated the effects of two antidepressants, nortriptyline (n=13), a tricyclic, and paroxetine (n=16), an SRI inhibitor, on HR variability in patients with panic disorder, using a measure of chaos, the largest Lyapunov exponent (LLE) using pre- and posttreatment HR time series. Our results show that nortriptyline is associated with a decrease in LLE of high frequency (HF: 0.15-0.5 Hz) filtered series, which is most likely due to its anticholinergic effect, while paroxetine had no such effect. Paroxetine significantly decreased sympathovagal ratios as measured by a decrease in LLE of LF/HF. These results suggest that paroxetine appears to be safer in regards to cardiovascular effects compared to nortriptyline in this group of patients.
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Affiliation(s)
- Vikram Kumar Yeragani
- Department of Psychiatry, Wayne State University School of Medicine, Detroit, MI, USA.
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Jacob S, Sebastian JC, Abraham G. Depression and congestive heart failure: are antidepressants underutilized? Eur J Heart Fail 2003; 5:399-400. [PMID: 12798840 DOI: 10.1016/s1388-9842(02)00297-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Khawaja IS, Feinstein RE. Cardiovascular effects of selective serotonin reuptake inhibitors and other novel antidepressants. HEART DISEASE (HAGERSTOWN, MD.) 2003; 5:153-60. [PMID: 12713682 DOI: 10.1097/01.hdx.0000061695.97215.64] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
This paper reviews the current knowledge of cardiovascular effects of the most commonly used novel antidepressants and their possible interactions with cardiovascular medications. The literature was reviewed through Medline 1980-2001. Materials were located by using terms such as SSRIs, individual names of novel antidepressants matched with terms like cardiovascular effects, cardiovascular diseases, cardiovascular risk factors, etc. Drug compendiums from 1998-2001 and some psychopharmacology texts were also used. The article focuses on the cardiovascular effects of the newer antidepressants, their use in patients with cardiovascular disease, and interactions with various commonly used cardiovascular drugs.
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Affiliation(s)
- Imran S Khawaja
- Lakeland Mental Health Center and Department of Psychiatry and Behavioral Science, Fergus Falls, MN 56537, USA
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Yeragani VK, Pesce V, Jayaraman A, Roose S. Major depression with ischemic heart disease: effects of paroxetine and nortriptyline on long-term heart rate variability measures. Biol Psychiatry 2002; 52:418-29. [PMID: 12242058 DOI: 10.1016/s0006-3223(02)01394-x] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Studies have linked depression to sudden death and serious cardiovascular events in patients with preexisting cardiac illness. Recent studies have shown decreased vagal function in cardiac patients with depression and depressed patients without cardiac illness. METHODS We compared 20-hour, sleeping, and awake heart period variability measures using spectral analysis, fractal dimension, and symbolic dynamics in two patient groups with major depression and ischemic heart disease (mean age 59-60 years) before and after 6 weeks of paroxetine or nortriptyline treatment. RESULTS Spectral measures showed decreases in awake and sleeping total power (TP: 0.0-0.5 Hz), ultra low frequency power (ULF: 0-0.0033 Hz), very low frequency power (VLF: 0.0033-0.04 Hz), and low-frequency power (LF: 0.04-0.15 Hz) for nortriptyline condition and a decrease in high-frequency power (HF: 0.15-0.5 Hz) for the awake condition in patients who received nortriptyline. A measure of nonlinear complexity, WC-100, significantly increased after paroxetine during the awake condition. CONCLUSIONS These findings suggest that nortriptyline has stronger vagolytic effects on cardiac autonomic function compared with paroxetine, which is in agreement with previous clinical and preclinical reports. Paroxetine may have some cardio-protective effects, especially in cardiac patients.
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Affiliation(s)
- Vikram K Yeragani
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University School of Medicine, Detroit, Michigan, USA
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Yeragani VK, Rao KARK, Smitha MR, Pohl RB, Balon R, Srinivasan K. Diminished chaos of heart rate time series in patients with major depression. Biol Psychiatry 2002; 51:733-44. [PMID: 11983187 DOI: 10.1016/s0006-3223(01)01347-6] [Citation(s) in RCA: 99] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Depression and anxiety have been linked to serious cardiovascular events in patients with preexisting cardiac illness. A decrease in cardiac vagal function as suggested by a decrease in heart rate (HR) variability has been linked to sudden death. METHODS We compared LLE and nonlinearity scores of the unfiltered (UF) and filtered time series (very low, low, and high frequency; VLF, LF and HF) of HR between patients with depression (n = 14) and healthy control subjects (n = 18). RESULTS We found significantly lower LLE of the unfiltered series in either posture, and HF series in patients with major depression in supine posture (p <.002). LLE (LF/UF), which may indicate relative sympathetic activity was also significantly higher in supine and standing postures in patients (p <.05); LF/HF (LLE) was also higher in patients (p <.05) in either posture. CONCLUSIONS These findings suggest that major depression is associated with decreased cardiac vagal function and a relative increase in sympathetic function, which may be related to the higher risk of cardiovascular mortality in this group and illustrates the usefulness of nonlinear measures of chaos such as LLE in addition to the commonly used spectral measures.
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Affiliation(s)
- Vikram Kumar Yeragani
- Department of Psychiatry, Wayne State University School of Medicine, Detroit, Michigan, USA
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Feinstein RE, Khawaja IS, Nurenberg JR, Frishman WH. Cardiovascular effects of psychotropic drugs. Curr Probl Cardiol 2002; 27:190-240. [PMID: 12060825 DOI: 10.1067/mcd.2002.125053] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Torta R, Scalabrino A. [Depression, anxiety and cardiovascular disease: biological correlations and therapeutic strategies]. EPIDEMIOLOGIA E PSICHIATRIA SOCIALE 2002; 11:73-82. [PMID: 12212468 DOI: 10.1017/s1121189x00005534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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