Depression and Comorbid Cardiovascular Disease

It is important to understand the interplay of medical and psychiatric disorders. Charles B. Nemeroff, MD, PhD, Reunette W. Harris Professor and Chairman, Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, offered a review of the relationships between cardiovascular disease and depressive disorders at this year's American Psychiatric Association annual meeting.

Depression

Depression is the most common psychological problem in the US. Minor Depression can be attributed to normal depressed feelings that arise because of a specific life situation, a side effect of medication, hormonal changes or physical illness, and does not usually require treatment. Major Depression (depressive illness) is a serious condition that result in extreme fatigue, sleep problems and eventually an inability to function. The exact cause is unknown, but it is thought to be a malfunction of brain neurotransmitters, which are chemicals that modulate moods. Major Depression is usually treated with a combination of psychotherapy and antidepressants which moderate or correct chemical imbalances in the brain. The group of antidepressants most frequently prescribed is the selective serotonin reuptake inhibitors (SSRIs) which regulate the neurotransmitter serotonin.

Examples:

Amitriptyline HCL
WELLBUTRIN
Wellbutrin SR
Fluoxetine
Celexa
Lexapro
Paxil
Prozac
Remeron
Zoloft
Effexor XR

Several large studies have now demonstrated a relationship between depression and ischemic heart disease (IHD).

A study by Anda and colleagues followed more than 2800 participants for a mean of 12.4 years and demonstrated that patients with depressed affect and/or moderate/severe hopelessness, as assessed by a general well-being schedule given during their initial baseline assessment, had a much higher risk for both fatal and nonfatal IHD. This study clearly suggested that depressive-like symptomatology may be a risk factor for the subsequent development of IHD. Depression is also very common in patients with coronary artery disease (CAD). Approximately 23% of patients met Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria for depression in a study by Gonzalez and colleagues. In this study, both family history of psychopathology and the severity of medical illness were significant predictions of depression.

In another study, patients who met DSM-III-R criteria for depression 7 days after a myocardial infarction (MI) were also assessed both 6 months and 18 months after an acute MI. The rate of coronary deaths among the nondepressed patients (n = 187) was approximately 3% at 6 months and 6% at 18 months. Among the depressed patients (n = 35), the incidence of coronary death was approximately 16.5% at 6 months and 20% at 18 months, demonstrating that depression particularly increased the rate of coronary death within 6 months of the initial MI. The results from the Baltimore ECA follow-up study also determined the role of major depression as a risk factor for MI and factored in the involvement of psychotropic medications. This study demonstrated that depression increased the risk of developing an MI by 4.54, and even dysphoria increased the odds ratio for developing an MI by over 2-fold. This study also demonstrated barbiturates, phenothiazines, and lithium were associated with an increased MI risk. whereas tricyclic antidepressants (TCAs) were not. A number of large prospective studies in patients without CAD upon study entry have now demonstrated that depression is a significant independent risk factor for CAD, with an adjusted relative risk in the range of 1.5- to 2-fold, which is similar to tobacco and smoking.