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Chong RJ, Hao Y, Tan EWQ, Mok GJL, Sia CH, Ho JSY, Chan MYY, Ho AFW. Prevalence of Depression, Anxiety and Post-Traumatic Stress Disorder (PTSD) After Acute Myocardial Infarction: A Systematic Review and Meta-Analysis. J Clin Med 2025; 14:1786. [PMID: 40142595 PMCID: PMC11943088 DOI: 10.3390/jcm14061786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2024] [Revised: 02/23/2025] [Accepted: 03/03/2025] [Indexed: 03/28/2025] Open
Abstract
Background: Mental illnesses following an acute myocardial infarction (AMI) are a growing concern, as they are associated with worse outcomes for AMI patients. Our understanding of the prevalence of mental illnesses after an AMI is incomplete, as most studies investigate depression while overlooking other conditions like anxiety and PTSD. Existing studies often rely on patient-reported questionnaires for mental illness diagnoses, a method that can be subjective. To address this, we conducted a systematic review and meta-analysis to determine the prevalence and risk factors of depression, anxiety, and PTSD after AMI, including only studies with formal mental illness diagnoses. Methods: Searches in MEDLINE, EMBASE, and PsycINFO up to 23 January 2025 identified 23 qualifying studies that assessed the prevalence of depression, anxiety, and PTSD after AMI, with cases defined exclusively by formal diagnoses established through psychiatrist-administered structured interviews according to the Diagnostic and Statistical Manual for Mental Disorders (DSM) criteria (versions III to V). For each outcome, the pooled prevalence was estimated using meta-analyses of proportions with random-effects models. If significant heterogeneity was detected, subgroup analyses and meta-regression were performed to explore the factors contributing to this heterogeneity. Results: A total of 25 studies were included in the meta-analysis. Among the 20 studies included, the pooled prevalence of depression after AMI was 23.58% (95% CI: 22.86%; 24.32%). When stratified by time since AMI, the prevalence was 19.46% (95% CI: 15.47%; 24.19%) for those assessed within 3 months and 14.87% (95% CI: 9.55%; 22.43%) for those assessed after 3 months. The pooled prevalence of anxiety (seven studies) and PTSD (three studies) was 11.96% (95% CI: 6.15; 21.96%) and 10.26% (95% CI: 5.49%; 18.36%), respectively. Further pooled prevalence subgroup analysis of depression and anxiety revealed significantly higher rates in the female sex (29.89%, 95% CI: 21.85; 39.41%), in those with hypertension (25.01%, 95% CI: 21.68; 28.67%), diabetes (25.01%, 95% CI: 21.68; 28.67%), or hyperlipidemia (28.96% 95% CI: 23.44; 35.17%), and in smokers (25.23%., 95% CI: 19.48; 32.00%), while the pooled prevalence of depression is higher in unmarried (35.44%, 95% CI: 19.61; 55.26%) than married individuals (28.63%, 95% CI: 18.67; 41.20%) and in those with a history of depression (57.41%, 95% CI: 31.47; 78.92%). The results of the meta-regression indicated that a prior history of depression was a significant predictor of depression prevalence (p = 0.0035, regression coefficient 1.54). Conclusions: The prevalence of mental illnesses, including depression, anxiety, and PTSD, is notable following an AMI. Identified risk factors encompass female sex, hypertension, diabetes mellitus, hyperlipidemia, smoking, a history of depressive illness, and social context.
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Affiliation(s)
- Ray Junrui Chong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore;
| | - Yunrui Hao
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore;
| | - Emily Wei Qi Tan
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 639798, Singapore; (E.W.Q.T.); (G.J.L.M.)
| | - Grace Jing Le Mok
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore 639798, Singapore; (E.W.Q.T.); (G.J.L.M.)
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (C.-H.S.); (M.Y.Y.C.)
| | - Jamie Sin Ying Ho
- Department of Medicine, National University Hospital, Singapore 119074, Singapore;
| | - Mark Yan Yee Chan
- Department of Cardiology, National University Heart Centre Singapore, Singapore 119074, Singapore; (C.-H.S.); (M.Y.Y.C.)
| | - Andrew Fu Wah Ho
- Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore
- Pre-Hospital & Emergency Research Centre, Duke-National University of Singapore Medical School, Singapore 169857, Singapore
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore 117549, Singapore
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Kang G, Zhang H, Zhou J, Wan D. The WeChat platform-based health education improves health outcomes among patients with stable coronary artery disease. PATIENT EDUCATION AND COUNSELING 2023; 111:107704. [PMID: 36906932 DOI: 10.1016/j.pec.2023.107704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/03/2023] [Accepted: 03/04/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the effect of the WeChat platform-based health education on patients with stable coronary artery disease (CAD) compared with usual care. METHODS We conducted a randomized controlled trial that included patients with stable CAD who were admitted to the Bin Hai Wan Central Hospital of Dongguan between January 2020 and December 2020. Participants in the control group received a standard regimen of care. In the WeChat group, the patients were provided with the WeChat platform-based health education by multidisciplinary team members in addition to usual care. The coprimary outcome of the study was the blood pressure, lipid profile, fasting blood glucose, Hamilton Anxiety Scale (HAMA) scores, Hamilton Depression Scale (HAMD) scores and Seattle Angina Questionnaire (SAQ) scores at 12 months, relative to baseline levels. RESULTS Between January 2020 and December 2020, 200 eligible CAD patients were randomly assigned to WeChat group (n = 100) or usual care group (n = 100). After 12 months, the number of participants who knew the risk factors, symptoms, diagnostic criteria, management methods and treating target of CAD was significantly larger in the WeChat group than at baseline (P < 0.05) and also larger than the post-intervention level of the control group (P < 0.05). The systolic blood pressure after intervention of the WeChat group significantly decreased compared to those of the control group (132.06 ± 8.87 mmHg vs 140.32 ± 9.42 mmHg; P < 0.05). After intervention, the triglycerides, total cholesterol, and low-density lipoprotein cholesterol of the WeChat group significantly decreased compared to those at baseline and significantly decreased than those in the control group (all P < 0.05). After the intervention, scores of HAMA and HAMD both significantly decreased in the two groups. Moreover, the decreases were more significant in the WeChat group than in the control group (5.78 ± 0.98 vs 8.54 ± 1.24; 6.27 ± 1.03 vs 8.63 ± 1.66; P < 0.05). The SAQ scores of WeChat group were significantly higher than those of the control group in all 5 dimensions at the 1-year follow-up (72.71 ± 10.83 vs 59.32 ± 9.86; 80.01 ± 11.56 vs 61.98 ± 11.02; 76.76 ± 12.64 vs 65.22 ± 10.72; 83.17 ± 13.06 vs 67.01 ± 12.86; 71.82 ± 12.78 vs 55.79 ± 11.90; all P < 0.05). CONCLUSION This study showed the high efficacy of the WeChat platform-based health education in improving health outcomes in patients with CAD. PRACTICE IMPLICATIONS This study highlighted the potential of social media as a helpful tool for health education among patients with CAD.
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Affiliation(s)
- GuanYang Kang
- Department of Cardiology, Bin Hai Wan Central Hospital of Dongguan, The Dongguan Affiliated Hospital of Jinan University (also called The Fifth People's Hospital of Dongguan, Taiping People's Hospital of Dongguan), Dongguan, Guangdong, China.
| | - HuiQing Zhang
- Department of Clinical Pharmacy, Bin Hai Wan Central Hospital of Dongguan, The Dongguan Affiliated Hospital of Jinan University (also called The Fifth People's Hospital of Dongguan, Taiping People's Hospital of Dongguan), Dongguan, Guangdong, China
| | - Jian Zhou
- Department of Cardiovascular Medicine, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200123, China
| | - DeLi Wan
- Department of Cardiology, Bin Hai Wan Central Hospital of Dongguan, The Dongguan Affiliated Hospital of Jinan University (also called The Fifth People's Hospital of Dongguan, Taiping People's Hospital of Dongguan), Dongguan, Guangdong, China
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3
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Co-prevalence and incidence of myocardial infarction and/or stroke in patients with depression and/or anxiety: A systematic review and meta-analysis. J Psychosom Res 2023; 165:111141. [PMID: 36610338 DOI: 10.1016/j.jpsychores.2022.111141] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Co-prevalence and incidence of depression and/or anxiety with stroke and myocardial infarction are currently unclear. This paper explores the relationships, as these are important comorbidities affecting patient outcomes. METHODS A systematic search across five databases (PubMed, Scopus, PsycINFO, Embase, Cochrane) was conducted for observational studies reporting co-prevalence of depression or anxiety with stroke or myocardial infarction. We used random-effects models in all meta-analyses and evaluated heterogeneity using I2. RESULTS This analysis included 48 studies with a total of 57,342 patients. In patients with depression, the pooled prevalence of stroke was 5.9% (95% CI = 5.53-6.37). In patients with myocardial infarction, the pooled prevalence of anxiety and depression was 9.1% (95% CI = 7.07-11.40, I2 = 85.6%) and 25.9% (95% CI = 18.46-34.12, I2 = 99.1%), respectively, and the pooled cumulative incidence of depression at one year was 20.5% (95% CI = 18.36-22.79). The pooled prevalence of anxiety and depression in patients with stroke was 13.5% (95% CI = 7.67-22.66, I2 = 96.9%) and 23.0% (95% CI = 17.93-28.99, I2 = 96.7%), respectively. The pooled cumulative incidences of depression at two weeks, three months, six months, and one year, were 29.1% (95% CI = 26.60-31.81), 17.0% (95% CI = 10.74-25.92, I2 = 98.0%), 7.4% (95% CI = 6.52-8.49), and 9.1% (95% CI = 3.71-20.79, I2 = 99.8%), respectively. CONCLUSIONS This meta-analysis outlines the co-morbid burden between depression/anxiety and stroke/myocardial infarction. Future research should be done to evaluate the effectiveness of screening anxiety/depression in myocardial infarction/stroke.
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Husain-Krautter S, Ellison JM. Late Life Depression: The Essentials and the Essential Distinctions. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2021; 19:282-293. [PMID: 34690594 DOI: 10.1176/appi.focus.20210006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Late life depression (LLD), a familiar syndrome, is not differentiated in the DSM-5. LLD can resemble depressive syndromes in younger adults but it differs in demographic characteristics, phenomenology, prognosis, treatment, suicide risk, relationship to other disorders, and etiology. Older depressed adults often present with fewer major depressive symptoms, less emphasis on mood disturbance, greater preoccupation with somatic or psychotic symptoms, and misleading cognitive deficits. LLD's relationships with medical and neurocognitive symptoms and with inflammatory and immune factors are complex. Formal screening tools and biopsychosocial assessment informs diagnosis and treatment. Evidence supports the effectiveness of lifestyle interventions, several psychotherapies, and a variety of somatic treatment approaches. Comorbid medical disorders must be taken into account when planning treatment. In this article, the authors describe the characteristics of LLD, present an approach to assessment and management, and recommend that future DSM editions include a new specifier to differentiate LLD from other depressive syndromes.
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Affiliation(s)
- Sehba Husain-Krautter
- Zucker Hillside Hospital, North Shore, Long Island Jewish Health System, Glen Oaks, New York (Husain-Krautter); Litwin-Zucker Research Center for the Study of Alzheimer's Disease, Feinstein Institute for Medical Research, Manhasset, New York (Husain-Krautter); Swank Center for Memory Care and Geriatric Consultation, ChristianaCare, Wilmington, Delaware (Ellison); Sidney Kimmel College of Medicine, Thomas Jefferson University, Philadelphia (Ellison)
| | - James M Ellison
- Zucker Hillside Hospital, North Shore, Long Island Jewish Health System, Glen Oaks, New York (Husain-Krautter); Litwin-Zucker Research Center for the Study of Alzheimer's Disease, Feinstein Institute for Medical Research, Manhasset, New York (Husain-Krautter); Swank Center for Memory Care and Geriatric Consultation, ChristianaCare, Wilmington, Delaware (Ellison); Sidney Kimmel College of Medicine, Thomas Jefferson University, Philadelphia (Ellison)
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Nair R, Johnson M, Kravitz K, Huded C, Rajeswaran J, Anabila M, Blackstone E, Menon V, Lincoff AM, Kapadia S, Khot UN. Characteristics and Outcomes of Early Recurrent Myocardial Infarction After Acute Myocardial Infarction. J Am Heart Assoc 2021; 10:e019270. [PMID: 34333986 PMCID: PMC8475017 DOI: 10.1161/jaha.120.019270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background We aimed to understand the characteristics and outcomes of patients readmitted with a recurrent myocardial infarction (RMI) within 90 days of discharge after an acute myocardial infarction (early RMI). Methods and Results We analyzed the timing of reinfarction, etiology, and outcome for all patients admitted with an early RMI within 90 days of discharge after an acute myocardial infarction between January 1, 2010 and January 1, 2017. We identified 6626 admissions for acute myocardial infarction (index myocardial infarction) which led to 168 cases of RMI within 90 days of discharge. The mean patient age was 65.1±13.1 years, and 37% were women. The 90-day probability of readmission with an early RMI was 2.5%. Black race, medical management, higher troponin T, and shorter length of stay were independent predictors of early RMI. Medically managed group had a higher risk for early RMI compared with percutaneous coronary intervention (P=0.04) or coronary artery bypass grafting (P=0.2). Predominant mechanisms for reinfarction were stent thrombosis (17%), disease progression (12%), and unchanged coronary artery disease (11%). At 5 years, the all-cause mortality rate for patients with an early RMI was 49% (95% CI, 40%-57%) compared with 22% (95% CI, 21%-23%) for patients without an early RMI (P<0.0001). Conclusions Early RMI is a life-threatening condition with nearly 50% mortality within 5 years. Stent-related events and progression in coronary artery disease account for most early RMI. Medication compliance, aggressive risk factor management, and care transitions should be the cornerstone in preventing early RMI.
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Affiliation(s)
- Raunak Nair
- Cleveland Clinic Heart, Vascular and Thoracic Institute Cleveland OH.,Cleveland Clinic Heart, Vascular and Thoracic Institute Center for Healthcare Delivery Innovation Cleveland OH
| | - Michael Johnson
- Cleveland Clinic Heart, Vascular and Thoracic Institute Center for Healthcare Delivery Innovation Cleveland OH.,University Cardiology Associates Augusta GA
| | - Kathleen Kravitz
- Cleveland Clinic Heart, Vascular and Thoracic Institute Cleveland OH.,Cleveland Clinic Heart, Vascular and Thoracic Institute Center for Healthcare Delivery Innovation Cleveland OH
| | - Chetan Huded
- Cleveland Clinic Heart, Vascular and Thoracic Institute Center for Healthcare Delivery Innovation Cleveland OH.,Saint Luke's Mid America Heart Institute Kansas City MO
| | | | - Moses Anabila
- Cleveland Clinic Heart, Vascular and Thoracic Institute Cleveland OH
| | - Eugene Blackstone
- Cleveland Clinic Heart, Vascular and Thoracic Institute Cleveland OH
| | - Venu Menon
- Cleveland Clinic Heart, Vascular and Thoracic Institute Cleveland OH
| | - A Michael Lincoff
- Cleveland Clinic Heart, Vascular and Thoracic Institute Cleveland OH
| | - Samir Kapadia
- Cleveland Clinic Heart, Vascular and Thoracic Institute Cleveland OH
| | - Umesh N Khot
- Cleveland Clinic Heart, Vascular and Thoracic Institute Cleveland OH.,Cleveland Clinic Heart, Vascular and Thoracic Institute Center for Healthcare Delivery Innovation Cleveland OH
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Hung HH, Chen WC, Chen YH, Chiu LT, Chen HY. Evaluation of the efficacy of Chinese herbal medicine and acupuncture for the prevention of mental disorders in interstitial cystitis patients: A nationwide population-based study. Medicine (Baltimore) 2020; 99:e21422. [PMID: 32791761 PMCID: PMC7386994 DOI: 10.1097/md.0000000000021422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Traditional Chinese medicine (TCM) is commonly used for urinary symptoms in Eastern countries. Since there are few effective treatments available for patients with interstitial cystitis/bladder pain syndrome (IC/BPS), the psychological burden leads to increased healthcare-seeking behavior. Some patients may therefore seek TCM treatment for related urinary symptoms. Due to limited clinical research evaluating the effects of TCM on IC/BPS, we conducted a nationwide population-based cohort study to investigate the relationship between TCM and mental disorders among these patients. The IC/BPS cohort and its matched non-IC/BPS comparison cohort were recruited from the National Health Insurance (NHI) Research Database between 2000 and 2011. Patients with the use of Chinese herbal medicine (CHM) granules or acupuncture over 90 days per year were enrolled as the TCM users. Multivariable Cox proportional hazards models were used to evaluate the hazard ratio (HR) of mental disorders related to interstitial cystitis. The incidence of mental disorders in the 2 cohorts was assessed with Kaplan-Meier curves. A total of 1123 patients with IC/BPS and 4492 matched non-IC/BPS subjects were included in this study. The IC/BPS cohort demonstrated higher incidence rate of mental disorders than the cohort without IC/BPS (adjusted HR: 2.21, 95% confidence interval [CI]: 1.73-2.81). There was no statistically significant difference in the risk of mental disorders between IC/BPS patients with and without CHM granules or acupuncture treatment (adjusted HR: 0.99, 95% CI: 0.58-1.68). Our results indicated that CHM and acupuncture showed insignificant efficacy in the prevention of mental disorders in IC/BPS patients.
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Affiliation(s)
| | - Wen-Chi Chen
- Graduate Institute of Integrated Medicine, College of Chinese Medicine
- Departments of Obstetrics and Gynecology, Urology, and Medical Research
| | - Yung-Hsiang Chen
- Graduate Institute of Integrated Medicine, College of Chinese Medicine
- Departments of Obstetrics and Gynecology, Urology, and Medical Research
- Department of Psychology, College of Medical and Health Science, Asia University
| | - Lu-Ting Chiu
- Management office for Health Data, China Medical University Hospital
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Huey-Yi Chen
- Graduate Institute of Integrated Medicine, College of Chinese Medicine
- Departments of Obstetrics and Gynecology, Urology, and Medical Research
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Abstract
The old classification of depression as reactive and endogenous, which are still observed in clinical practice, both cannot be accommodated under the current rubric of major depression. This is because psychiatric nosology under the Diagnostic and Statistical Manual of Mental Disorders (DSM) and its latest fifth edition (DSM-V) is still descriptive and not etiologic. The aim of this review was to revisit reactive and endogenous categories of depression from the perspective of today's understanding of etiological pathways. From an epigenetic perspective, the old dichotomy of reactive versus endogenous is interrelated through the impact of the environment (e.g., stress). This includes familial or prenatal depression, where the environmental impact is before birth, or childhood depression, where the early life stress is the precipitating factor to genetic susceptibility. In conclusion, searching for both environmental impact (e.g., stressors) and genetic predispositions in depression, even at a clinical level, could help clinicians with better therapeutic decisions.
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De Luca C, Colangelo AM, Alberghina L, Papa M. Neuro-Immune Hemostasis: Homeostasis and Diseases in the Central Nervous System. Front Cell Neurosci 2018; 12:459. [PMID: 30534057 PMCID: PMC6275309 DOI: 10.3389/fncel.2018.00459] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 11/12/2018] [Indexed: 01/08/2023] Open
Abstract
Coagulation and the immune system interact in several physiological and pathological conditions, including tissue repair, host defense, and homeostatic maintenance. This network plays a key role in diseases of the central nervous system (CNS) by involving several cells (CNS resident cells, platelets, endothelium, and leukocytes) and molecular pathways (protease activity, complement factors, platelet granule content). Endothelial damage prompts platelet activation and the coagulation cascade as the first physiological step to support the rescue of damaged tissues, a flawed rescuing system ultimately producing neuroinflammation. Leukocytes, platelets, and endothelial cells are sensitive to the damage and indeed can release or respond to chemokines and cytokines (platelet factor 4, CXCL4, TNF, interleukins), and growth factors (including platelet-derived growth factor, vascular endothelial growth factor, and brain-derived neurotrophic factor) with platelet activation, change in capillary permeability, migration or differentiation of leukocytes. Thrombin, plasmin, activated complement factors and matrix metalloproteinase-1 (MMP-1), furthermore, activate intracellular transduction through complement or protease-activated receptors. Impairment of the neuro-immune hemostasis network induces acute or chronic CNS pathologies related to the neurovascular unit, either directly or by the systemic activation of its main steps. Neurons, glial cells (astrocytes and microglia) and the extracellular matrix play a crucial function in a “tetrapartite” synaptic model. Taking into account the neurovascular unit, in this review we thoroughly analyzed the influence of neuro-immune hemostasis on these five elements acting as a functional unit (“pentapartite” synapse) in the adaptive and maladaptive plasticity and discuss the relevance of these events in inflammatory, cerebrovascular, Alzheimer, neoplastic and psychiatric diseases. Finally, based on the solid reviewed data, we hypothesize a model of neuro-immune hemostatic network based on protein–protein interactions. In addition, we propose that, to better understand and favor the maintenance of adaptive plasticity, it would be useful to construct predictive molecular models, able to enlighten the regulating logic of the complex molecular network, which belongs to different cellular domains. A modeling approach would help to define how nodes of the network interact with basic cellular functions, such as mitochondrial metabolism, autophagy or apoptosis. It is expected that dynamic systems biology models might help to elucidate the fine structure of molecular events generated by blood coagulation and neuro-immune responses in several CNS diseases, thereby opening the way to more effective treatments.
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Affiliation(s)
- Ciro De Luca
- Laboratory of Morphology of Neuronal Network, Department of Public Medicine, University of Campania-Luigi Vanvitelli, Naples, Italy
| | - Anna Maria Colangelo
- Laboratory of Neuroscience "R. Levi-Montalcini", Department of Biotechnology and Biosciences, University of Milano-Bicocca, Milan, Italy.,SYSBIO Centre of Systems Biology, University of Milano-Bicocca, Milan, Italy
| | - Lilia Alberghina
- Laboratory of Neuroscience "R. Levi-Montalcini", Department of Biotechnology and Biosciences, University of Milano-Bicocca, Milan, Italy.,SYSBIO Centre of Systems Biology, University of Milano-Bicocca, Milan, Italy
| | - Michele Papa
- Laboratory of Morphology of Neuronal Network, Department of Public Medicine, University of Campania-Luigi Vanvitelli, Naples, Italy.,SYSBIO Centre of Systems Biology, University of Milano-Bicocca, Milan, Italy
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9
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Shruthi DR, Kumar SS, Desai N, Raman R, Sathyanarayana Rao TS. Psychiatric comorbidities in acute coronary syndromes: Six-month follow-up study. Indian J Psychiatry 2018; 60:60-64. [PMID: 29736064 PMCID: PMC5914265 DOI: 10.4103/psychiatry.indianjpsychiatry_94_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Acute coronary syndrome (ACS) caused by coronary atherosclerosis include ST-segment elevation myocardial infarction (STEMI), non-STEMI, and unstable angina. The relation between psychiatric disorders and coronary artery disease is a complex one which includes the effect of the psychosocial factors on heart and vice versa. Point prevalence studies have been reported, but there is paucity of follow-up studies from India. MATERIALS AND METHODS The study is a follow-up evaluation at discharge of 248 consecutive patients presented with ACS at JSS Hospital, Mysuru, Karnataka, over a period of 6 months to assess the psychiatric comorbidities. The patients were assessed on a structured and validated pro forma before discharge, at 3 months, and at 6 months. Screening of psychiatric disorders was done using Mini International Neuropsychiatric Interview PLUS 5.0.0 and assessment of depression was done using Hamilton Depression Rating Scale. ANOVA, Student's t-test, and SPSS 21 were used for statistical analysis. RESULTS The most common psychiatric comorbidities include major depressive disorder (44%), it persisted at the end of 3 (P < 0.001) and 6 (P < 0.001) months. A spectrum of anxiety disorders including panic disorder (12.10%), dysthymia (3.60%), agoraphobia (2.40%), social phobia (2%), obsessive-compulsive disorder (1.6%), specific phobia (1.2%), and posttraumatic stress disorder (0.8%) in descending order at the end of 6 months were found. Significant reduction in substance use of nicotine (66.1%) and alcohol (56.0%) was reported on follow-up. CONCLUSION Depression, anxiety, and substance use occur in patients with ACS which persist on follow-up. Early recognition at discharge and appropriate counseling on follow-up improve the clinical outcomes.
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Affiliation(s)
- D. Ramya Shruthi
- Department of Psychiatry, JSS Medical College Hospital, JSS Academy of Higher Education and Research, Formerly JSS University, Mysuru, Karnataka, India
| | - S. Sunil Kumar
- Department of Cardiovascular and Thoracic Sciences, JSS Medical College Hospital, JSS Academy of Higher Education and Research, Formerly JSS University, Mysuru, Karnataka, India
| | - Nagaraj Desai
- Department of Cardiovascular and Thoracic Sciences, JSS Medical College Hospital, JSS Academy of Higher Education and Research, Formerly JSS University, Mysuru, Karnataka, India
| | - Rajesh Raman
- Department of Psychiatry, JSS Medical College Hospital, JSS Academy of Higher Education and Research, Formerly JSS University, Mysuru, Karnataka, India
| | - T. S. Sathyanarayana Rao
- Department of Psychiatry, JSS Medical College Hospital, JSS Academy of Higher Education and Research, Formerly JSS University, Mysuru, Karnataka, India
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De Luca C, Virtuoso A, Maggio N, Papa M. Neuro-Coagulopathy: Blood Coagulation Factors in Central Nervous System Diseases. Int J Mol Sci 2017; 18:E2128. [PMID: 29023416 PMCID: PMC5666810 DOI: 10.3390/ijms18102128] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 09/30/2017] [Accepted: 10/08/2017] [Indexed: 12/30/2022] Open
Abstract
Blood coagulation factors and other proteins, with modulatory effects or modulated by the coagulation cascade have been reported to affect the pathophysiology of the central nervous system (CNS). The protease-activated receptors (PARs) pathway can be considered the central hub of this regulatory network, mainly through thrombin or activated protein C (aPC). These proteins, in fact, showed peculiar properties, being able to interfere with synaptic homeostasis other than coagulation itself. These specific functions modulate neuronal networks, acting both on resident (neurons, astrocytes, and microglia) as well as circulating immune system cells and the extracellular matrix. The pleiotropy of these effects is produced through different receptors, expressed in various cell types, in a dose- and time-dependent pattern. We reviewed how these pathways may be involved in neurodegenerative diseases (amyotrophic lateral sclerosis, Alzheimer's and Parkinson's diseases), multiple sclerosis, ischemic stroke and post-ischemic epilepsy, CNS cancer, addiction, and mental health. These data open up a new path for the potential therapeutic use of the agonist/antagonist of these proteins in the management of several central nervous system diseases.
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Affiliation(s)
- Ciro De Luca
- Laboratory of Neuronal Networks, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.
| | - Assunta Virtuoso
- Laboratory of Neuronal Networks, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.
| | - Nicola Maggio
- Department of Neurology, The Chaim Sheba Medical Center, Tel Hashomer, 52621 Ramat Gan, Israel.
- Department of Neurology and Neurosurgery, Sackler Faculty of Medicine and Sagol School of Neuroscience, Tel Aviv University, 6997801 Tel Aviv, Israel.
| | - Michele Papa
- Laboratory of Neuronal Networks, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.
- SYSBIO, Centre of Systems Biology, University of Milano-Bicocca, 20126 Milano, Italy.
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Kumar M, Nayak PK. Psychological sequelae of myocardial infarction. Biomed Pharmacother 2017; 95:487-496. [PMID: 28866415 DOI: 10.1016/j.biopha.2017.08.109] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 08/08/2017] [Accepted: 08/23/2017] [Indexed: 01/10/2023] Open
Abstract
Patient with myocardial infarction (MI) are often affected by psychological disorders such as depression, anxiety, and post-traumatic stress disorder. Psychological disorders are disabling and have a negative influence on recovery, reduce the quality of life and causes high mortality rate in MI patients. Despite tremendous advancement in technologies, screening scales, and treatment strategies, psychological sequelae of MI are currently understudied, underestimated, underdiagnosed, and undertreated. Depression is highly prevalent in MI patients followed by anxiety and post-traumatic stress disorder. Pathophysiological factors involved in psychopathologies observed in patients with MI are sympathetic over-activity, hypothalamic-pituitary-adrenal axis dysfunction, and inflammation. Numerous preclinical and clinical studies evidenced a positive association between MI and psychopathologies with a common molecular pathophysiology. This review provides an update on diagnostic feature, prevalence, pathophysiology, clinical outcomes, and management strategies of psychopathologies associated with MI. Moreover, preclinical research findings on molecular mechanisms involved in post-MI psychopathologies and future therapeutic strategies have been outlined in the review.
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Affiliation(s)
- Mukesh Kumar
- Department of Pharmaceutical Engineering and Technology, Indian Institute of Technology (Banaras Hindu University), Varanasi, Uttar Pradesh, India.
| | - Prasanta Kumar Nayak
- Department of Pharmaceutical Engineering and Technology, Indian Institute of Technology (Banaras Hindu University), Varanasi, Uttar Pradesh, India.
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Rash JA, Lavoie KL, Sigal RJ, Campbell DJT, Manns BJ, Tonelli M, Campbell TS. The OPTIMIZE trial: Rationale and design of a randomized controlled trial of motivational enhancement therapy to improve adherence to statin medication. Contemp Clin Trials 2016; 49:47-56. [PMID: 27282119 DOI: 10.1016/j.cct.2016.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 05/30/2016] [Accepted: 06/04/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Statins are a class of medications that are particularly effective for lowering cholesterol and reducing cardiovascular morbidity and mortality. Despite a range of benefits, non-adherence to statin medication is prevalent with 50% to 75% of patients failing to adhere to treatment within the first 2-years. A previous review on interventions to improve adherence to cholesterol lowering medication concluded that rigorous trials were needed with emphasis on the patient's perspective and shared decision making. Motivational interviewing (MInt) is a promising patient-centered approach for improving adherence in patients with chronic diseases. This manuscript describes the rational and design of a randomized controlled trial (RCT) testing the efficacy of MInt in improving adherence to statin medication. METHODS Patients filling their first statin prescription will be recruited to complete a 6-month observation run-in period (phase-1) after which medication possession ratio (MPR) will be assessed. Patients meeting criteria for non-adherence (MPR≤60%) will be invited to participate in the trial. 336 non-adherent new statin users will undergo a fasting lipid panel, complete baseline questionnaires, and be randomly allocated to receive four sessions of adherence education delivered using MInt (EdMInt) or to an education control (EC) delivered at 3-month intervals. Final assessments will occur 12-months after the first EdMInt or EC session. The primary outcome is change in MPR adherence to statin medication from baseline to 12-months. Secondary outcomes include within-patient change in self-reported medication adherence, stage of change and self-efficacy for medication adherence, motivation to adhere to statin medication, and lipid profile.
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Affiliation(s)
- Joshua A Rash
- Department of Psychology, University of Calgary, 2500 University Drive N.W., Calgary, AB, Canada
| | - Kim L Lavoie
- Department of Psychology, University of Quebec at Montreal (UQAM), CP 8888, Succursale Centre-Ville, Montreal, QC, H3C 3P8, Canada; Montreal Behavioral Medicine Centre (MBMC), Research Centre, Hopital du Sacre-Coeur de Montreal, 5400 Gouin Blvd West, J-3145, Montreal, QC, H2J 1C5, Canada
| | - Ronald J Sigal
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - David J T Campbell
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Braden J Manns
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Marcello Tonelli
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Tavis S Campbell
- Department of Psychology, University of Calgary, 2500 University Drive N.W., Calgary, AB, Canada.
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Zaninotto P, Sacker A, Breeze E, McMunn A, Steptoe A. Gender-specific changes in well-being in older people with coronary heart disease: evidence from the English Longitudinal Study of Ageing. Aging Ment Health 2016; 20:432-40. [PMID: 25774880 PMCID: PMC5577641 DOI: 10.1080/13607863.2015.1020410] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The objective of this study is to investigate gender-specific trajectories in well-being among older people with coronary heart disease (CHD) and to compare them with those of healthy people. METHOD The study included a sample of 4496 participants from the first three waves of the English Longitudinal Study of Ageing (2002-2003 to 2006-2007). We measured well-being using quality of life (CASP-19; 'control', 'autonomy', 'pleasure' and 'self-realization') and depressive caseness (three or more symptoms on the CESD-8; Centre for Epidemiologic Study Depression scale). RESULTS After adjustment, at two- and four-years follow-ups, women had three points higher quality of life than men (p < 0.001). When looking at each quality of life's domain we found that women reported higher scores of autonomy compared to men. The gender difference in the probability of having depressive caseness reduced to 7 percentage points at four-year follow-up from 13 percentage points in the previous occasions. Men's quality of life declined progressively over time by 3 points (p < 0.001) (equivalent to the effect of having diabetes) but no changes in prevalence of depressive caseness were found. Women's quality of life only declined after four-year follow-up by less than 2 points (p < 0.001), while in the same period their probability of reporting depressive caseness reduced by 6 percentage points (p < 0.001). CONCLUSION Women had better quality of life than men in the two and four years following a CHD event, and were not more likely than men to report depressive caseness in the long term. Men's quality of life deteriorated progressively over time, among women it did not deteriorate in the first two years following a CHD event; women had a long-term improvement in depressive caseness.
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Affiliation(s)
- Paola Zaninotto
- Research Department of Epidemiology and Public Health, 1-19 Torrington Place, UCL, WC1E 7HB London, Phone 0044(0)2076791668
| | - Amanda Sacker
- Department of Epidemiology and Public Health, 1-19 Torrington Place, UCL, WC1E 7HB London, Phone 0044(0)2076791711
| | - Elizabeth Breeze
- Research Department of Epidemiology and Public Health, 1-19 Torrington Place, UCL, WC1E 7HB London, Phone 0044(0)2076791656
| | - Anne McMunn
- Research Department of Epidemiology and Public Health, 1-19 Torrington Place, UCL, WC1E 7HB London, Phone 0044(0)2076791730
| | - Andrew Steptoe
- Research Department of Epidemiology and Public Health, 1-19 Torrington Place, UCL, WC1E 7HB London, Phone 0044(0)2076791804
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Zurkovsky L, Taylor WD, Newhouse PA. Cognition as a therapeutic target in late-life depression: potential for nicotinic therapeutics. Biochem Pharmacol 2013; 86:1133-44. [PMID: 23933385 PMCID: PMC3856552 DOI: 10.1016/j.bcp.2013.07.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 07/25/2013] [Accepted: 07/26/2013] [Indexed: 12/19/2022]
Abstract
Depression is associated with impairments to cognition and brain function at any age, but such impairments in the elderly are particularly problematic because of the additional burden of normal cognitive aging and in some cases, structural brain pathology. Individuals with late-life depression exhibit impairments in cognition and brain structural integrity, alongside mood dysfunction. Antidepressant treatment improves symptoms in some but not all patients, and those who benefit may not return to the cognitive and functional level of nondepressed elderly. Thus, for comprehensive treatment of late-life depression, it may be necessary to address both the affective and cognitive deficits. In this review, we propose a model for the treatment of late-life depression in which nicotinic stimulation is used to improve cognitive performance and improve the efficacy of an antidepressant treatment of the syndrome of late-life depression. The cholinergic system is well-established as important to cognition. Although muscarinic stimulation may exacerbate depressive symptoms, nicotinic stimulation may improve cognition and neural functioning without a detriment to mood. While some studies of nicotinic subtype specific receptor agonists have shown promise in improving cognitive performance, less is known regarding how nicotinic receptor stimulation affects cognition in depressed elderly patients. Late-life depression thus represents a new therapeutic target for the development of nicotinic agonist drugs. Parallel treatment of cognitive dysfunction along with medical and psychological approaches to treating mood dysfunction may be necessary to ensure full resolution of depressive illness in aging.
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Affiliation(s)
- Lilia Zurkovsky
- Center for Cognitive Medicine, Department of Psychiatry, Vanderbilt University School of Medicine, 1601 23rd Avenue South, Nashville, TN 37212, United States
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Bruchas RR, de las Fuentes L, Carney RM, Reagan JL, Bernal-Mizrachi C, Riek AE, Gu CC, Bierhals A, Schootman M, Malmstrom TK, Burroughs TE, Stein PK, Miller DK, Dávila-Román VG. The St. Louis African American health-heart study: methodology for the study of cardiovascular disease and depression in young-old African Americans. BMC Cardiovasc Disord 2013; 13:66. [PMID: 24011389 PMCID: PMC3847628 DOI: 10.1186/1471-2261-13-66] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 08/13/2013] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Coronary artery disease (CAD) is a major cause of death and disability worldwide. Depression has complex bidirectional adverse associations with CAD, although the mechanisms mediating these relationships remain unclear. Compared to European Americans, African Americans (AAs) have higher rates of morbidity and mortality from CAD. Although depression is common in AAs, its role in the development and features of CAD in this group has not been well examined. This project hypothesizes that the relationships between depression and CAD can be explained by common physiological pathways and gene-environment interactions. Thus, the primary aims of this ongoing project are to: a) determine the prevalence of CAD and depression phenotypes in a population-based sample of community-dwelling older AAs; b) examine the relationships between CAD and depression phenotypes in this population; and c) evaluate genetic variants from serotoninP and inflammatory pathways to discover potential gene-depression interactions that contribute significantly to the presence of CAD in AAs. METHODS/DESIGN The St. Louis African American Health (AAH) cohort is a population-based panel study of community-dwelling AAs born in 1936-1950 (inclusive) who have been followed from 2000/2001 through 2010. The AAH-Heart study group is a subset of AAH participants recruited in 2009-11 to examine the inter-relationships between depression and CAD in this population. State-of-the-art CAD phenotyping is based on cardiovascular characterizations (coronary artery calcium, carotid intima-media thickness, cardiac structure and function, and autonomic function). Depression phenotyping is based on standardized questionnaires and detailed interviews. Single nucleotide polymorphisms of selected genes in inflammatory and serotonin-signaling pathways are being examined to provide information for investigating potential gene-depression interactions as modifiers of CAD traits. Information from the parent AAH study is being used to provide population-based prevalence estimates. Inflammatory and other biomarkers provide information about potential pathways. DISCUSSION This population-based investigation will provide valuable information on the prevalence of both depression and CAD phenotypes in this population. The study will examine interactions between depression and genetic variants as modulators of CAD, with the intent of detecting mechanistic pathways linking these diseases to identify potential therapeutic targets. Analytic results will be reported as they become available.
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Affiliation(s)
- Robin R Bruchas
- Cardiovascular Imaging and Clinical Research Core Laboratory, Cardiovascular Division, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8086, St. Louis, MO 63110, USA
- Endocrinology, Metabolism and Lipid Research Division, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA
| | - Lisa de las Fuentes
- Cardiovascular Imaging and Clinical Research Core Laboratory, Cardiovascular Division, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8086, St. Louis, MO 63110, USA
- Division of Biostatistics, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8067, St. Louis, MO 63110, USA
| | - Robert M Carney
- Department of Psychiatry, Washington University School of Medicine, 4320 Forest Park Avenue Suite 301, St. Louis, MO 63108, USA
| | - Joann L Reagan
- Cardiovascular Imaging and Clinical Research Core Laboratory, Cardiovascular Division, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8086, St. Louis, MO 63110, USA
| | - Carlos Bernal-Mizrachi
- Endocrinology, Metabolism and Lipid Research Division, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA
| | - Amy E Riek
- Endocrinology, Metabolism and Lipid Research Division, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA
| | - Chi Charles Gu
- Division of Biostatistics, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8067, St. Louis, MO 63110, USA
| | - Andrew Bierhals
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA
| | - Mario Schootman
- Division of Health Behavior Research, Washington University School of Medicine, 660 south Euclid Avenue, St. Louis, MO 63110, USA
| | - Theodore K Malmstrom
- Department of Neurology & Psychiatry, School of Medicine, Saint Louis University, St. Louis, MO, USA
| | - Thomas E Burroughs
- Center for Outcomes Research, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO 63104, USA
| | - Phyllis K Stein
- Cardiovascular Imaging and Clinical Research Core Laboratory, Cardiovascular Division, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8086, St. Louis, MO 63110, USA
| | - Douglas K Miller
- Regenstrief Institute, Inc., and Indiana University Center for Aging Research, School of Medicine, Indiana University, 410 West 10th Street, Indianapolis, IN 46202, USA
| | - Victor G Dávila-Román
- Cardiovascular Imaging and Clinical Research Core Laboratory, Cardiovascular Division, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8086, St. Louis, MO 63110, USA
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16
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Manjarrez-Gutiérrez G, Ramírez-Campillo R, Borrayo-Sánchez G, Hernández-Rodríguez J. Disturbance of serotonergic neurotransmission in patients with postmyocardial infarction and depression. Metab Brain Dis 2013; 28:15-20. [PMID: 23129293 DOI: 10.1007/s11011-012-9355-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 10/28/2012] [Indexed: 10/27/2022]
Abstract
The objective of this study was to assess the hypothesis that patients who develop depression after myocardial infarction (MI) have a lower level of brain serotonergic neurotransmission through measurement of plasma free fraction of L-tryptophan and intensity-dependence auditory-evoked potentials (IDAEPs). A cross-sectional study was carried out in 74 adults after MI. Thirty-four patients suffered from depression and 40 patients did not demonstrate depressive symptoms. We measured the free fraction, bound and total plasma L-tryptophan, and neutral amino acids as well as recording IDAEPs. Patients who developed depression after MI showed a significantly lower level in the free fraction of L-tryptophan and in the ratios of free fraction of L-tryptophan/total L-tryptophan and free fraction of L-tryptophan/neutral amino acids. It is noteworthy that the slope of the amplitude/stimulus intensity functions (ASF slope) of the N1/P2 component was significantly higher post-MI in depressed patients. Higher ASF slope of the N1/P2 component associated with a low free fraction of L-tryptophan in plasma reflect a low brain serotonergic neurotransmission. These findings suggest an important deterioration of brain serotonergic activity as a pathophysiological mechanism in post-MI patients for the development of clinical depression. Therefore, we propose these biochemical and electrophysiological procedures as noninvasive clinical indicators of brain serotonergic activity in these patients.
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Affiliation(s)
- Gabriel Manjarrez-Gutiérrez
- Laboratorio de Patología Molecular, Unidad de Investigación Biomolecular, Hospital de Cardiología, Centro Médico Nacional Siglo XXI (CMN-SXXI), Instituto Mexicano del Seguro Social (IMSS), Av. Cuauhtémoc 330, México, DF, México.
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Williams MS. Platelets and depression in cardiovascular disease: A brief review of the current literature. World J Psychiatry 2012; 2:114-23. [PMID: 24175177 PMCID: PMC3782186 DOI: 10.5498/wjp.v2.i6.114] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2011] [Revised: 09/19/2012] [Accepted: 11/17/2012] [Indexed: 02/05/2023] Open
Abstract
Major depression is an independent risk factor for cardiovascular mortality and morbidity. The exact mechanisms linking depression and increased cardiovascular risk remain poorly understood. Several mechanisms have been proposed including increased platelet reactivity. This review focuses on the current literature that examines the platelet hypothesis of depression. To date studies show increased serotonin response, increased platelet serotonin receptor density, decreased serotonin transporter binding, and decreased platelet serotonin levels in individuals with depression. However other studies have shown no change in serotonin uptake. In addition to platelet serotonin specific pathways, other platelet pathways that have shown significant changes in depressed individuals include blunting of the platelet adenosine response, increased platelet thrombin response, increased glycoprotein Ib expression, increased P-selectin, β thromboglobulin, and platelet factor four, as well as decreased platelet brain derived neurotrophic factor. However there are other studies that show conflicting evidence of increased platelet activation as measured by integrin receptor α2bβ3. Other conflicting data include α adrenergic density and platelet response to augmented serotonin. The direction of future research in platelet functional changes in depression and coronary artery disease should continue to focus on serotonin specific pathways with emphasis on potential mechanisms of specific pathway changes.
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Affiliation(s)
- Marlene S Williams
- Marlene S Williams, Division of Cardiology, Johns Hopkins Bayview Medical Center, The Johns Hopkins University, Baltimore, MD 21224, United States
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Sarkar S, Chadda RK, Kumar N, Narang R. Anxiety and depression in patients with myocardial infarction: findings from a centre in India. Gen Hosp Psychiatry 2012; 34:160-6. [PMID: 22036738 DOI: 10.1016/j.genhosppsych.2011.09.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 09/19/2011] [Accepted: 09/20/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The study was conducted to assess the occurrence of anxiety and depression in patients with recent myocardial infarction (MI) and also to assess the relationship of these symptoms with other relevant factors and clinical outcome. METHODS A total of 103 patients with recent MI attending the cardiology outpatient department (OPD) of a tertiary care centre in India were included. The patients were evaluated using Hamilton Anxiety Rating Scale (HAM-A), Hamilton Depression Rating Scale (HAM-D) and Mini International Neuropsychiatric Interview (MINI), and pertinent demographic and clinical parameters were recorded. The patients were followed up at 12 weeks telephonically to ascertain outcome. RESULTS Significant anxiety and depressive symptoms were present in 48.5% and 25.2% of the sample. Anxiety or depressive disorder diagnosis was present in 25.2% of the sample. Aspirin use predicted lower anxiety and depressive symptom scores. A multivariate linear regression showed that female sex, history of angina and use of aspirin independently predicted scores on HAM-A. Diagnosis of psychiatric disorder, use of aspirin and increased body mass index also independently predicted scores on HAM-D. CONCLUSIONS There is a need to screen for anxiety and depressive symptoms in patients with MI, so that appropriate intervention can be incorporated in the management plan.
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Affiliation(s)
- Siddharth Sarkar
- Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, Delhi-110029, India.
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Abstract
BACKGROUND Cardiovascular events are inconclusively associated with duloxetine use in clinical trials and spontaneous reports. This analysis of cardiovascular events in relation to duloxetine use within a large health insurance database provides further data on the association. METHODS This cohort study was conducted within a population with commercial health insurance. Adults with depression who initiated duloxetine were matched to separate cohorts of initiators of venlafaxine, selective serotonin reuptake inhibitors (SSRIs), and tricyclic antidepressants (TCAs), along with untreated patients with depression, and enrollees without depression. The cohorts were followed for cardiovascular events (acute myocardial infarction, sudden death, hypertensive crisis, arrhythmia, and coronary revascularization), which were identified through health insurance claims and confirmed upon review of underlying medical records. Proportional hazards and Poisson regression models were used for comparisons. RESULTS There were approximately 64,000 person-years of follow-up among all cohorts (including 17,386 person-years among 21,457 duloxetine initiators), yielding 279 cardiovascular events. Relative to duloxetine initiators, those without depression had lower rates of combined events (incidence rate ratio [IRR], 0.51; 95% confidence interval [CI], 0.32-0.81) and coronary revascularizations (IRR, 0.51; 95% CI 0.29-0.89). The IR of each of the cardiovascular outcomes did not differ across the other cohorts, even accounting for time since last duloxetine dispensing. CONCLUSION The incidence of cardiovascular events did not differ among duloxetine initiators relative to other antidepressant comparators or those with untreated depression but was higher than those without depression, suggesting that depression itself (or associated morbidities) may affect the risk of cardiovascular events.
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Roose S, Deuschle M. Depression and cardiovascular disorders. HANDBOOK OF CLINICAL NEUROLOGY 2012; 106:541-556. [PMID: 22608643 DOI: 10.1016/b978-0-444-52002-9.00032-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Affiliation(s)
- Steven Roose
- Department of Psychiatry, Columbia University, New York, NY, USA
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Bekke-Hansen S, Trockel M, Burg MM, Taylor CB. Depressive symptom dimensions and cardiac prognosis following myocardial infarction: results from the ENRICHD clinical trial. Psychol Med 2012; 42:51-60. [PMID: 21682949 DOI: 10.1017/s0033291711001000] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Depression following myocardial infarction (MI) independently increases risk for early cardiac morbidity and mortality. Studies suggest that somatic, but not cognitive, depressive symptoms are responsible for the increased risk. However, the effects of somatic depressive symptoms at follow-up, after sufficient time has elapsed to allow for physical recovery from the initial infarction, are not known. Our aim was to examine the relationship between cognitive and somatic depressive symptom dimensions at baseline and 12 months post-MI and subsequent mortality and cardiovascular morbidity. METHOD Patients were 2442 depressed and/or socially isolated men and women with acute MI included in the Enhancing Recovery in Coronary Heart Disease (ENRICHD) clinical trial. We used principal components analysis (PCA) of the Beck Depression Inventory (BDI) items to derive subscales measuring cognitive and somatic depressive symptom dimensions, and Cox regression with Bonferroni correction for multiple testing to examine the contribution of these dimensions to all-cause mortality, cardiovascular mortality, and first recurrent non-fatal MI. RESULTS After adjusting for medical co-morbidity and Bonferroni correction, the somatic depressive symptom dimension assessed proximately following MI did not significantly predict any endpoints. At 12 months post-MI, however, this dimension independently predicted subsequent all-cause [hazard ratio (HR) 1.43, 95% confidence interval (CI) 1.13-1.81] and cardiovascular mortality (HR 1.60, 95% CI 1.17-2.18). No significant associations were found between the cognitive depressive symptom dimension and any endpoints after Bonferroni correction. CONCLUSIONS Somatic symptoms of depression at 12 months post-MI in patients at increased psychosocial risk predicted subsequent mortality. Psychosocial interventions aimed at improving cardiac prognosis may be enhanced by targeting somatic depressive symptoms, with particular attention to somatic symptom severity at 12 months post-MI.
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Affiliation(s)
- S Bekke-Hansen
- Department of Psychology, Aarhus University, Aarhus, Denmark.
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22
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Sheikh AI, Marotta SA. Best Practices for Counseling in Cardiac Rehabilitation Settings. JOURNAL OF COUNSELING AND DEVELOPMENT 2011. [DOI: 10.1002/j.1556-6678.2008.tb00632.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Affiliation(s)
- Krishnamachari Srinivasan
- Department of Psychiatry, St. John's Medical College and St. John's Research Institute, Bangalore, Karnataka, India
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Abstract
In this article we review the role of depression and other related psychological factors in heart disease. The prevalence of heart disease in patients with depression is high, and epidemiological links between depression and heart disease are evident in studies of community samples, psychiatric patients, and heart disease patients. We also describe the links between heart disease and related psychological factors-including vital exhaustion, Type A behavior pattern, anger and hostility, and Type D personality-and summarize proposed mechanisms that may link negative affects with heart disease. Finally, we review treatment of depression in heart disease, including evidence from several large clinical trials.
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Affiliation(s)
- Laura K Kent
- Department of Psychiatry, Columbia University/New York State Psychiatric Institute, New York, NY 10032, USA.
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Marano G, Harnic D, Lotrionte M, Biondi-Zoccai G, Abbate A, Romagnoli E, Mazza M. Depression and the cardiovascular system: increasing evidence of a link and therapeutic implications. Expert Rev Cardiovasc Ther 2009; 7:1123-47. [PMID: 19764865 DOI: 10.1586/erc.09.78] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This review explores the epidemiological evidence for the relationship between depression and cardiovascular disease from a mechanistic standpoint. It is important to examine the biological, behavioral and social mechanisms to improve outcomes for depressed cardiac patients. A number of plausible biobehavioral mechanisms linking depression and cardiovascular disease have been identified. Tricyclic antidepressants have various effects on the cardiovascular system, while selective serotonin reuptake inhibitors are not associated with adverse cardiac effects and should, therefore, be the preferred choice for the treatment of most patients with comorbid depression and cardiovascular disease.
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Affiliation(s)
- Giuseppe Marano
- Department of Neuroscience, Institute of Psychiatry and Psychology, Catholic University of Sacred Heart, Rome, Italy
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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: 2.5] [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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King KM, Colella TJF, Faris P, Thompson DR. Using the cardiac depression scale in men recovering from coronary artery bypass surgery. J Clin Nurs 2009; 18:1617-24. [DOI: 10.1111/j.1365-2702.2009.02800.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Are illness perceptions about coronary artery disease predictive of depression and quality of life outcomes? J Psychosom Res 2009; 66:211-20. [PMID: 19232233 DOI: 10.1016/j.jpsychores.2008.09.005] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2007] [Revised: 08/13/2008] [Accepted: 09/04/2008] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Depression occurs commonly in coronary artery disease (CAD) and is associated with substantial disability. Modifiable cognitive determinants of depression in this population have not been identified. We investigated the impact of potentially modifiable illness beliefs about CAD on depressive symptomatology. We also examined the association between these beliefs and health-related quality of life (HRQOL) and socio-demographic variations in illness beliefs. METHODS A prospective study of 193 recently hospitalized CAD patients was conducted. Data were collected from medical records and by self-report 3 and 9 months post-discharge. Socio-demographic differences were analysed with independent sample t-tests. Predictive models were tested in a series of hierarchical linear regression equations that controlled for known clinical, psychosocial, and demographic correlates of outcome. RESULTS Negative illness beliefs, particularly those associated with the consequences of CAD, were significantly predictive of higher levels of depressive symptomatology at 3 and 9 months. Positive illness perceptions were significantly associated with better HRQOL outcomes. Older and less socially advantaged patients demonstrated more negative illness beliefs. CONCLUSIONS Illness beliefs are significantly associated with depressive symptomatology and HRQOL in CAD patients. These beliefs can be easily identified and constitute a meaningful and clinically accessible avenue for improving psychological morbidity and HRQOL in CAD patients. Older and more socially vulnerable patients may require heightened monitoring of their illness beliefs. Research needs to translate these and other predictive findings into interventions.
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Cognitive-personality style as vulnerability to depression in patients with coronary artery disease: roles of sociotropy and autonomy. Psychosom Med 2009; 71:63-9. [PMID: 18941132 DOI: 10.1097/psy.0b013e318187c023] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate whether the cognitive-personality styles of sociotropy and autonomy and their component subscales are useful for explaining depressogenic vulnerability in a population of individuals with coronary artery disease (CAD) and to better understand the psychosocial etiology of depression in CAD. Depression occurs commonly in patients with CAD and is associated with substantial disability. METHOD A prospective study of 193 recently hospitalized CAD patients was conducted. Data were collected from medical records and by self-report at 3 (Time 1, T1) and 9 (Time 2, T2) months post discharge. The association between cognitive-personality styles and depression was tested in hierarchical linear regression equations controlling for clinical and demographic confounders. RESULTS High levels of autonomy were significantly associated with increased depressive symptomatology at T1 (p < .001) and T2 (p < .001). The association between autonomy and change in depression approached significance (p = .07). Sociotropy was not a significant predictor of depression at any time. The component subscales of the sociotropy and autonomy measures explained more variance in depressive symptomatology at T1 and T2 as well as change in depression than did the composite measures. The perfectionism subscale of autonomy was the most important predictor of depression at T1 and T2 contributing 5.3% and 5.1% of unique variance in depression, respectively. There was a trend for the association between perfectionism and change in depression (p = .06). CONCLUSION Cognitive-personality characteristics are an important predictor of depression in recently hospitalized patients with CAD. The findings suggest a clinical benefit in early detection of highly autonomous patients, particularly those who exhibit perfectionism, coupled with appropriate cognitive intervention and collaborative treatment planning.
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Abstract
Approximately 20% of patients with coronary heart disease (CHD) have major depression and 20% have minor depression at any given point in the course of their illness. Depression causes significant psychological and social morbidity, and is a risk factor for further cardiac morbidity and mortality. Although there are many possible biological and behavioral mechanisms, the causal pathways through which depression increases the risk for cardiac events and death are not well understood. Despite the morbidity associated with depression, and the devastating impact it has on the quality of life of patients with CHD, it is underdiagnosed and often left untreated. This article describes screening techniques for use in primary care and cardiology settings, and discusses the safety and efficacy of available treatments for depression in patients with CHD.
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Affiliation(s)
- Robert M Carney
- Behavioral Medicine Center, Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri 63108, USA.
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Schlienger RG, Meier CR. Effect of selective serotonin reuptake inhibitors on platelet activation: can they prevent acute myocardial infarction? Am J Cardiovasc Drugs 2008; 3:149-62. [PMID: 14727927 DOI: 10.2165/00129784-200303030-00001] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
In recent years a large body of evidence from several longitudinal studies has emerged suggesting that depression is an independent risk factor for cardiovascular disease (CVD) and that the association between depression and increased CVD risk is not merely due to negative mood-driven behavior related with depression. Even though the underlying mechanisms are not well understood, several hypotheses and explanations have been proposed such as increased activation of the hypothalamic-pituitary-adrenal axis, abnormalities in the sympathoadrenal system, or abnormalities in platelet function. Platelet function abnormalities, including increased platelet reactivity, may predispose patients with depressive disorders to clotting diatheses and may explain their vulnerability to CVD. Serotonin secreted by platelets induces both platelet aggregation and coronary vasoconstriction. Even though serotonin itself is only a weak platelet agonist, it markedly enhances platelet reactions to a variety of other agonists. Several studies have shown that selective serotonin reuptake inhibitors (SSRIs) reduce platelet and whole blood serotonin concentrations after repeated doses, and could therefore exert an inhibitory effect on platelet activation. For that reason, it was hypothesized that SSRIs could have a protective effect against myocardial infarction (MI). Results from three currently available epidemiological studies assessing the risk of MI in patients treated with antidepressants, including SSRIs, are controversial with respect to a potential beneficial effect of SSRIs on CVD risk in depressed patients. However, there is evidence that exposure to SSRIs does not substantially increase the risk of CVD in patients. A recent randomized, double-blind, placebo-controlled, multicenter trial that evaluated the safety and efficacy of the SSRI sertraline in patients with major depression and acute MI or unstable angina suggested that sertraline is well tolerated and effective. Further epidemiological studies or longer-term clinical trials may shed more light on this issue, and answer the question conclusively, whether the effect of SSRIs on platelets or another mechanism translates into a decreased risk of CVD in depressed patients.
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Affiliation(s)
- Raymond G Schlienger
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacology, University Hospital, Basel, Switzerland.
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Somberg TC, Arora RR. Depression and heart disease: therapeutic implications. Cardiology 2008; 111:75-81. [PMID: 18376116 DOI: 10.1159/000119692] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2007] [Accepted: 10/07/2007] [Indexed: 11/19/2022]
Abstract
The consequences of depression and coronary artery disease (CAD) were reviewed in the literature. The comorbidity of depression and CAD results in an increased cardiovascular mortality. We reviewed possible explanations for this increased morbidity, which include: toxicity of tricyclic antidepressants that can cause cardiac arrhythmias, abnormalities in platelet function leading to increased platelet aggregation due to abnormalities in serotonin in the platelet (an abnormality that possibly causes depression in the central nervous system), diffuse atherosclerosis causing central nervous system abnormalities including depression (vascular depression), as well as the possibility that depressed patients are less compliant with their medications and physician-directed health recommendations. Recent reports of selective serotonin reuptake inhibitors (SSRIs) causing a reduced cardiovascular mortality may be related to serotonin platelet abnormalities in depressed patients that are effectively treated by SSRIs (SADHART and ENRICHD trial). It is possible that these trials reveal a mechanism of depression that also effects platelet function and can be improved with SSRI therapy, suggesting a preferential therapeutic pathway for the treatment of depressed patients with CAD.
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Eich D, Neuhaus C, Gamma A, Angst J, Rössler W, Ajdacic-Gross V, Opravil M. Is depression a risk factor for heart complaints? Longitudinal aspects in the Zurich study. Eur Arch Psychiatry Clin Neurosci 2007; 257:396-401. [PMID: 17902006 DOI: 10.1007/s00406-007-0747-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2006] [Accepted: 05/04/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND The objective of this longitudinal study was to assess the association between major depression and heart complaints in a population of young and healthy adults. METHODS Starting at the age 20/21, participants of the Zurich Study underwent 6 structured, psychological interviews during a span of 20 years. We evaluated longitudinal data from 277 persons who participated in all 6 interviews including questions about heart complaints. RESULTS Over 20 years, heart complaints were reported by two thirds of participants, and the frequency of depression was 11.4%. At the age of 40/ 41, heart complaints were significantly associated with earlier heart complaints and major depression, both more often in women. Recurrent brief depression showed a tendency, but neither minor depression nor depressive symptoms were predictive for later heart complaints. CONCLUSIONS This study suggests that major depression is a predictor for heart complaints at the age of 40 and that the severity of depressive disorder in younger age has an effect on subsequent heart complaints. Follow-up data will help to elucidate whether these subjective heart complaints show any correlation with a later coronary heart disease.
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Affiliation(s)
- Dominique Eich
- Department of Clinical and Social Psychiatry, Zurich University Psychiatric Hospital, Lenggstrasse 31, PO Box 1931, 8032 Zurich, Switzerland.
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Milani RV, Lavie CJ. Impact of cardiac rehabilitation on depression and its associated mortality. Am J Med 2007; 120:799-806. [PMID: 17765050 DOI: 10.1016/j.amjmed.2007.03.026] [Citation(s) in RCA: 233] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2006] [Revised: 02/01/2007] [Accepted: 03/06/2007] [Indexed: 01/22/2023]
Abstract
PURPOSE Depression following major cardiac events is associated with higher mortality, but little is known about whether this can be reduced through treatment including cardiac rehabilitation and exercise training. We evaluated the impact of cardiac rehabilitation on depression and its associated mortality in coronary patients. PATIENTS AND METHODS We evaluated 522 consecutive coronary patients (381 men, 141 women; aged 64+/-10 years) enrolled in cardiac rehabilitation from January 2000 to July 2005 and a control group of 179 patients not completing rehabilitation. Depressive symptoms were assessed by questionnaire at baseline and following rehabilitation, and mortality was evaluated after a mean follow-up of 1296+/-551 days. RESULTS Prevalence of depressive symptoms decreased 63% following rehabilitation, from 17% to 6% (P <.0001). Depressed patients following rehabilitation had an over 4-fold higher mortality than nondepressed patients (22% vs 5%, P=.0004). Depressed patients who completed rehabilitation had a 73% lower mortality (8% vs 30%; P=.0005) compared with control depressed subjects who did not complete rehabilitation. Reductions in depressive symptoms and its associated mortality were related to improvements in fitness; however, similar reductions were noted in those with either modest or marked increases in exercise capacity. CONCLUSION In patients following major coronary events, cardiac rehabilitation is associated with both reductions in depressive symptoms and the excess mortality associated with it. Moreover, only mild improvements in levels of fitness appear to be needed to produce these benefits on depressive symptoms and its associated mortality.
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Affiliation(s)
- Richard V Milani
- Department of Cardiology, Ochsner Medical Center, New Orleans, La 70121, USA.
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Cagle AJ, Diehr P, Meischke H, Rea T, Olsen J, Rodrigues D, Yakovlevitch M, Amidon T, Eisenberg M. Psychological and social impacts of automated external defibrillators (AEDs) in the home. Resuscitation 2007; 74:432-8. [PMID: 17395358 DOI: 10.1016/j.resuscitation.2007.01.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2006] [Revised: 01/17/2007] [Accepted: 01/17/2007] [Indexed: 11/20/2022]
Abstract
BACKGROUND The majority of cardiac arrests occur in the home. The placement of AEDs in the homes of at-risk patients may save lives through early defibrillation. However, the impact of having an AED in the home on psychological outcomes and quality-of-life is unknown. OBJECTIVE The purpose of this research was to determine whether training in the use of and possessing an automated external defibrillator (AED) has an effect on a patient at risk's quality of life. METHODS We investigated the psychological consequences of AED training and possession of such a device for patients who recently experienced an acute ischemic event. One hundred fifty eight patients and their family members were assigned at random to receive cardiopulmonary resuscitation (CPR) training (N=66) or AED/CPR training and possession of the device after training (N=92). We measured quality of life using the Short-Form (SF-36) survey and a 9-item survey we developed specifically for this study to measure differences in social activities and worries about being left alone. Participants answered these questions at enrollment, 2 weeks, 3 months, and 3 months after enrollment. RESULTS Patients in the AED group reported lower (worse) scores on most SF-36 subscales at all periods, particularly in those subscales relating to social functioning. The differences were most often small and probably not clinically meaningful. The social activities/worry scales also favored the CPR group at all periods, but with no significant differences. CONCLUSIONS Physicians counselling patients about AEDs should be aware of the potential effects the device may have on a patient's social functioning.
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Affiliation(s)
- Anthony J Cagle
- University of Washington School of Public Health and Community Medicine, Seattle, WA, USA.
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Stafford L, Berk M, Jackson HJ. Validity of the Hospital Anxiety and Depression Scale and Patient Health Questionnaire-9 to screen for depression in patients with coronary artery disease. Gen Hosp Psychiatry 2007; 29:417-24. [PMID: 17888808 DOI: 10.1016/j.genhosppsych.2007.06.005] [Citation(s) in RCA: 187] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2007] [Revised: 06/17/2007] [Accepted: 06/19/2007] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Depression is common but frequently undetected in patients with coronary artery disease (CAD). Self-report screening instruments for assessing depression such as the Hospital Anxiety and Depression Scale (HADS) and the Patient Health Questionnaire-9 (PHQ-9) are available but their validity is typically determined in depressed patients without comorbid somatic illness. We investigated the validity of these instruments relative to a referent diagnostic standard in recently hospitalized patients with CAD. METHOD Three months post-discharge for a cardiac admission, 193 CAD patients completed the HADS and PHQ-9. The Mini International Neuropsychiatric Interview (MINI) was the criterion standard. Scale reliability was calculated using Cronbach's alpha. Convergent validity was computed using Pearson's intercorrelations. Sensitivity and specificity for various cut-off scores for both measures and for the PHQ-9 categorical algorithm were calculated using receiver operating characteristics (ROC). For analyses, participants were assigned to two groups, 'major depressive disorder' or 'any depressive disorder'. RESULTS For all calculations, alpha was 0.05 and tests were two-tailed. Internal consistencies for the two measures were excellent. Criterion validity for the PHQ-9 and HADS was good. We found no statistical differences between the PHQ-9 and HADS for detecting either group; however, the categorical algorithm of the PHQ-9 for diagnosing major depression had a superior LR+ when compared with the summed HADS or PHQ-9. The operating characteristics of the screening instruments for 'any depressive disorder' were slightly lower than for 'major depressive disorder'. Some optimum cut-off scores were lower than the generally recommended cut-off scores, particularly when screening for major depression (e.g., > or = 5/6 vs. > or = 10 and > or = 8 for PHQ-9 and HADS, respectively). Lowering the cut off scores substantially improved the sensitivity of these instruments while retaining specificity, thereby improving their usefulness to screen for CAD patients with depression. CONCLUSIONS Both instruments have acceptable properties for detecting depression in recently hospitalized cardiac patients, and neither scale is statistically superior when summed scores are used. The categorical algorithm of the PHQ-9 for diagnosing major depression has a superior LR+ compared to the summed PHQ-9 and HADS scores. Use of the generally recommended cut-off scores should be cautious. In light of the aversive outcomes associated with depression in CAD, screening for depression is a clinical priority.
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Affiliation(s)
- Lesley Stafford
- Department of Psychology, School of Behavioural Science, University of Melbourne, Victoria 3010, Australia.
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Stafford L, Berk M, Reddy P, Jackson HJ. Comorbid depression and health-related quality of life in patients with coronary artery disease. J Psychosom Res 2007; 62:401-10. [PMID: 17383491 DOI: 10.1016/j.jpsychores.2006.12.009] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2006] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This article reviews recent studies relating to the impact of depression and its treatment on the health-related quality of life (HRQOL) of patients with coronary artery disease (CAD). METHODS Articles for the primary review were identified via MEDLINE and PsycINFO (1995-2006). RESULTS Evidence suggests that depression has an aversive impact on the HRQOL of patients with stable CAD as well as on patients hospitalized for acute myocardial infarction and coronary artery bypass graft surgery. Unfortunately, there are few depression treatment studies in patients with CAD that make use of standardized HRQOL measures, but the limited evidence suggests that successful treatment has positive implications for HRQOL in these patients. The mechanisms through which depression impacts on HRQOL require further study but are likely to be behavioral. CONCLUSIONS Depressive symptoms significantly undermine HRQOL in patients with CAD despite successful medical and surgical management. Although successful treatment of depression has not been shown to reduce mortality rates in patients with CAD, further study may find that the HRQOL benefits of such treatment are equally valuable.
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Affiliation(s)
- Lesley Stafford
- Department of Psychology, School of Behavioural Science, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Victoria, Australia.
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Jaffe AS, Krumholz HM, Catellier DJ, Freedland KE, Bittner V, Blumenthal JA, Calvin JE, Norman J, Sequeira R, O'Connor C, Rich MW, Sheps D, Wu C. Prediction of medical morbidity and mortality after acute myocardial infarction in patients at increased psychosocial risk in the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) study. Am Heart J 2006; 152:126-35. [PMID: 16824842 DOI: 10.1016/j.ahj.2005.10.004] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2005] [Accepted: 10/03/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND Patients with myocardial infarction (MI) are at further increased risk for untoward events when patients also exhibit low social support and/or depression. The ENRICHD study was the largest controlled trial in post-MI patients attempting to treat these psychological comorbidities and provides an opportunity to examine the medical and psychological characteristics that may affect risk in this population. METHODS We analyzed the baseline characteristics and their relationship to the primary end point of long-term mortality and recurrent infarction and to the secondary end points of overall mortality and cardiovascular mortality in 2481 post-MI patients. Cox proportional hazards models were used to predict the risk of these outcomes over a mean of 2.5 years of follow-up. RESULTS Death or nonfatal MI occurred in 24.1%, all-cause mortality in 13.7%, and cardiovascular mortality in 8.4% of the sample (62% of the total). Age, heart failure, pulmonary disease, Killip class, ejection fraction, an elevated creatinine, the use of non-angiotensin-coverting enzyme asodilators, prior MI, diabetes, depression, and bypass surgery after acute MI were all significant multivariable predictors. CONCLUSIONS The medical predictors of adverse events in post-MI patients with low social support and/or depression were similar to those of patients with MI in other clinical trials.
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Affiliation(s)
- Allan S Jaffe
- Cardiovascular Division, Mayo Clinic, Rochester, MN 55905, USA.
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Ogedegbe G, Schoenthaler A, Richardson T, Lewis L, Belue R, Espinosa E, Spencer J, Allegrante JP, Charlson ME. An RCT of the effect of motivational interviewing on medication adherence in hypertensive African Americans: rationale and design. Contemp Clin Trials 2006; 28:169-81. [PMID: 16765100 DOI: 10.1016/j.cct.2006.04.002] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2005] [Revised: 02/27/2006] [Accepted: 04/12/2006] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hypertension disproportionately affects African Americans compared to whites, and it is the single most common explanation for the disparity in mortality between African Americans and whites. Adherence with antihypertensive medications can help reduce risk of negative hypertension-related outcomes. Motivational interviewing is a promising patient-centered approach for improving adherence in patients with chronic diseases. In this paper we describe the rationale and design of an ongoing randomized controlled trial testing the effectiveness of motivational interviewing versus usual care in improving medication adherence among 190 African American uncontrolled hypertensive patients, who receive care in a primary care setting. METHODS The usual care group receives standard medical care, while those in the intervention group receive standard care plus four sessions of motivational interviewing at 3-month intervals for a period of 1 year. This technique consists of brief, patient-driven counseling sessions to facilitate initiation and maintenance of behavior change. The primary outcome is adherence to prescribed antihypertensive medication, assessed with the electronic medication events monitoring system (MEMS) and the Morisky self-report adherence questionnaire. Secondary outcomes are within-patient changes in blood pressure, self-efficacy, and intrinsic motivation between baseline and 12 months. We report the baseline sociodemographic and clinical characteristics of the participants. CONCLUSIONS Despite the potential utility of motivational interviewing, little is known about its effectiveness in improving medication adherence among hypertensive patients, especially African Americans. In addition to the baseline data this study has generated, this trial should provide data with which we can assess the effectiveness of this approach as a behavioral intervention.
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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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Thombs BD, Bass EB, Ford DE, Stewart KJ, Tsilidis KK, Patel U, Fauerbach JA, Bush DE, Ziegelstein RC. Prevalence of depression in survivors of acute myocardial infarction. J Gen Intern Med 2006; 21:30-8. [PMID: 16423120 PMCID: PMC1484630 DOI: 10.1111/j.1525-1497.2005.00269.x] [Citation(s) in RCA: 567] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To assess the prevalence and persistence of depression in patients with acute myocardial infarction (AMI) and the relationship between assessment modality and prevalence. DATA SOURCES MEDLINE, Cochrane, CINAHL, PsycINFO, and EMBASE. REVIEW METHODS A comprehensive search was conducted in March 2004 to identify original research studies published since 1980 that used a standardized interview or validated questionnaire to assess depression. The search was augmented by hand searching of selected journals from October 2003 through April 2004 and references of identified articles and reviews. Studies were excluded if only an abstract was provided, if not in English, or if depression was not measured by a validated method. RESULTS Major depression was identified in 19.8% (95% confidence interval [CI] 19.1% to 20.6%) of patients using structured interviews (N=10,785, 8 studies). The prevalence of significant depressive symptoms based on a Beck Depression Inventory score > or =10 was 31.1% (CI 29.2% to 33.0%; N=2,273, 6 studies), using a Hospital Anxiety and Depression Scale (HADS) score > or =8%, 15.5% (CI 13.2% to 18.0%; N=863, 4 studies), and with a HADS score > or =11%, 7.3% (CI 5.5% to 9.3%; N=830, 4 studies). Although a significant proportion of patients continued to be depressed in the year after discharge, the limited number of studies and variable follow-up times precluded specification of prevalence rates at given time points. CONCLUSIONS Depression is common and persistent in AMI survivors. Prevalence varies depending on assessment method, likely reflecting treatment of somatic symptoms.
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Affiliation(s)
- Brett D Thombs
- Johns Hopkins University Evidence-based Practice Center, Johns Hopkins University School of Medicine, Baltimore, Md, USA
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de Jonge P, Spijkerman TA, van den Brink RHS, Ormel J. Depression after myocardial infarction is a risk factor for declining health related quality of life and increased disability and cardiac complaints at 12 months. Heart 2006; 92:32-9. [PMID: 15890765 PMCID: PMC1860990 DOI: 10.1136/hrt.2004.059451] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2005] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To study the prospective effects of post-myocardial infarction (MI) depressive disorder on health status, including self reported cardiac symptoms, disability, and health related quality of life, at 12 months after MI while controlling for cardiac condition and health status at three months after MI. METHODS Longitudinal study of a cohort of 468 adults with MI recruited from four hospitals in the north of The Netherlands between September 1997 and September 2000. Assessment of depressive disorder in the year after MI according to International classification of disease, 10th revision criteria. Assessment of health status at three and 12 months by the RAND 36 item health survey, the health complaints scale, self rated cardiac complaints, and disability. RESULTS Patients with post-MI depressive disorder were more likely than those without to have poor quality of life, more health complaints, more cardiac complaints, and more disability at 12 months' follow up. In multivariate analyses adjusted for cardiac condition, health status at three months, age, sex, and pre-MI depression, the prospective association of post-MI depression with poor health status remained for most of the indicators. Severity of the post-MI depression further contributed to aspects of poor health status. CONCLUSIONS In a prospective study design, post-MI depression had strong effects on poor health status exceeding the effects of cardiac condition and its short term consequences. Efforts to improve health status after MI should therefore include standard assessment and guideline based treatment of post-MI depressive disorder.
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Affiliation(s)
- P de Jonge
- Department of Psychiatry, University of Groningen, Groningen, The Netherlands.
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Evans DL, Charney DS, Lewis L, Golden RN, Gorman JM, Krishnan KRR, Nemeroff CB, Bremner JD, Carney RM, Coyne JC, Delong MR, Frasure-Smith N, Glassman AH, Gold PW, Grant I, Gwyther L, Ironson G, Johnson RL, Kanner AM, Katon WJ, Kaufmann PG, Keefe FJ, Ketter T, Laughren TP, Leserman J, Lyketsos CG, McDonald WM, McEwen BS, Miller AH, Musselman D, O'Connor C, Petitto JM, Pollock BG, Robinson RG, Roose SP, Rowland J, Sheline Y, Sheps DS, Simon G, Spiegel D, Stunkard A, Sunderland T, Tibbits P, Valvo WJ. Mood disorders in the medically ill: scientific review and recommendations. Biol Psychiatry 2005; 58:175-89. [PMID: 16084838 DOI: 10.1016/j.biopsych.2005.05.001] [Citation(s) in RCA: 688] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2005] [Revised: 04/29/2005] [Accepted: 05/03/2005] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The purpose of this review is to assess the relationship between mood disorders and development, course, and associated morbidity and mortality of selected medical illnesses, review evidence for treatment, and determine needs in clinical practice and research. DATA SOURCES Data were culled from the 2002 Depression and Bipolar Support Alliance Conference proceedings and a literature review addressing prevalence, risk factors, diagnosis, and treatment. This review also considered the experience of primary and specialty care providers, policy analysts, and patient advocates. The review and recommendations reflect the expert opinion of the authors. STUDY SELECTION/DATA EXTRACTION Reviews of epidemiology and mechanistic studies were included, as were open-label and randomized, controlled trials on treatment of depression in patients with medical comorbidities. Data on study design, population, and results were extracted for review of evidence that includes tables of prevalence and pharmacological treatment. The effect of depression and bipolar disorder on selected medical comorbidities was assessed, and recommendations for practice, research, and policy were developed. CONCLUSIONS A growing body of evidence suggests that biological mechanisms underlie a bidirectional link between mood disorders and many medical illnesses. In addition, there is evidence to suggest that mood disorders affect the course of medical illnesses. Further prospective studies are warranted.
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Affiliation(s)
- Dwight L Evans
- School of Medicine, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, USA.
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Sørensenf C, Friis-Hasché E, Haghfelt T, Bech P. Postmyocardial infarction mortality in relation to depression: a systematic critical review. PSYCHOTHERAPY AND PSYCHOSOMATICS 2005; 74:69-80. [PMID: 15741756 DOI: 10.1159/000083165] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The aim of this review was to survey the literature on depression in patients with myocardial infarction to assess the methodological quality and to test whether depression leads to an increased postmyocardial infarction mortality. Medline, Psycinfo, and www.UMI.com were searched, and researchers were contacted in the autumn of 2003. Thirty-one articles were reviewed. Only seven articles scored above a predefined level of 75% for acceptable quality. The articles lack description of non-responders, recall period for depressive symptoms, validation of applied instrument on target population, and sample size large enough to show differences between groups. The prevalence rates of depression ranged from 1.6 to 50%. In eight articles, a diagnostic test was applied, in the rest of the studies, questionnaires were used. The prevalence of depression was highest in those using patient-completed questionnaires. A significant positive association was shown between depression and postmyocardial infarction mortality in 15 studies, a non-significant association in 14, and in two articles, this was not reported. In articles with data collection starting after 1994, a non-significant relation tended to be reported. The studies were generally not of acceptable quality. They lacked sufficient power to show differences in stated end points between groups. Application of non-validated instruments caused large differences in prevalence rates of depression. Future studies should include a minimum of 1,000 patients, use a validated instrument, re-examine the patients, and describe participants and non-participants in detail.
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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: 3.3] [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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Silkey B, Preskorn SH, Golbeck A, Shah R, Neff M, Jones TL, Choi J. Complexity of medication use in the Veterans Affairs healthcare system: Part II. Antidepressant use among younger and older outpatients. J Psychiatr Pract 2005; 11:16-26. [PMID: 15650618 DOI: 10.1097/00131746-200501000-00003] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT A previous study, described in Part I of this report, found that 71% of a sample of 5,003 general outpatients in the Veterans Affairs healthcare system were receiving a unique drug regimen (i.e., total specific drug entities regardless of dose, formulation, or administration schedule). The simplest regimens contained only one drug, while the most complex regimens exceeded 20 different drugs. The purpose of the present study was to determine if patients receiving a specific therapeutic class of medications (e.g., antidepressants) have more homogeneous drug regimens. OBJECTIVE to examine the extent and complexity of multiple medication use in younger and older adult outpatients receiving antidepressants compared with those not receiving antidepressants. The study focused on drugs that act systemically or gastrointestinally and hence have the potential to interact. DESIGN, SETTING, AND PARTICIPANTS Two subsets of stratified random samples of outpatients selected from prescription databases of U.S. Veterans Integrated Service Network 15. The first group involved 1,991 patients deemed to be on antidepressants (AD patients): 891 aged < 60 years and 1,100 aged > or = 60 years. The second group involved 3,732 patients who had received no antidepressants within the previous 365 days but who had a supply of at least one other current prescription (NoAD patients): 1,195 aged < 60 years and 2,535 aged > or = 60 years; 2 missing age information. MAIN OUTCOME MEASURES number of drugs, frequency of drug regimens, level of multiple medication use including and excluding antidepressants. RESULTS Younger AD patients received 3 more drugs than younger NoAD patients. 23.6% of younger AD patients, versus 5.9% of younger NoAD patients, received > or = 8 drugs. Older AD patients received 2 more drugs than older NoAD patients. 37.6% of older AD patients, versus 12.8% of older NoAD patients, received > or = 8 drugs. In both the AD and NoAD groups, 62%-96% of patients of all ages were receiving unique drug regimens. Each drug regimen containing 2 or more drugs occurred in fewer than 1% of patients. CONCLUSIONS AD patients were receiving more complex drug regimens and had a higher frequency of unique drug regimens than NoAD patients, even when the results were adjusted for age group and number of prescribers. The high prevalence of unique drug combinations in all patient groups in this study indicates that clinicians in this system have only limited experience with the total effects of all of the medications their patients are receiving and thus cannot rely on experience to guard against adverse multi-drug interactions. This fact is a particular concern with psychiatric medications because adverse DDIs involving these medications can mimic psychiatric symptoms and may therefore be more difficult to detect.
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Affiliation(s)
- Beryl Silkey
- Via Christi Research Institute, Wichita, KS, USA
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Robinson KL, McBeth J, Macfarlane GJ. Psychological distress and premature mortality in the general population: a prospective study. Ann Epidemiol 2004; 14:467-72. [PMID: 15301783 DOI: 10.1016/j.annepidem.2003.11.007] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2002] [Accepted: 11/07/2003] [Indexed: 10/26/2022]
Abstract
PURPOSE To determine whether higher rates of mortality are observed in people reporting psychological distress, to establish the nature of any excess, and to examine the possible existence of a dose response relationship. METHODS We conducted a prospective follow-up study of mortality over an eight-year period in the North West of England. A total of 4,501 adults were recruited from two general practices during a population-based survey conducted at the start of 1992. At baseline psychological distress was assessed using the General Health Questionnaire (12-item version, GHQ-12). The relationship between levels of distress and subsequent mortality was examined using Cox proportional hazard models. RESULTS Risk of all-cause mortality was greatest in subjects reporting the highest levels of distress (hazard ratio (HR) 1.71, 95% CI 1.32-2.23) but was also raised in subjects reporting intermediate distress (HR 1.38 95% CI 1.06-1.79) when compared to those reporting no distress. Increased risk of mortality in subjects reporting distress appeared to be due largely to an excess of deaths from ischaemic heart disease (high distress, HR 1.90, 95% CI 1.08-3.35; intermediate distress, HR 1.58, 95% CI 0.90-2.76) and respiratory diseases (high distress, HR 5.39, 95% CI 2.70-10.78; intermediate distress, HR 2.33, 95% CI 1.12-4.22). CONCLUSIONS The association between mortality and psychological distress observed in this study seems to arise largely because of premature deaths from ischaemic heart disease and respiratory diseases. The existence of a dose-response effect between distress and mortality provides further evidence to support the existence of a casual relationship.
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Affiliation(s)
- Kate L Robinson
- Unit of Chronic Disease Epidemiology, The Medical School, University of Manchester, Manchester, UK
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Wulsin LR. Is depression a major risk factor for coronary disease? A systematic review of the epidemiologic evidence. Harv Rev Psychiatry 2004; 12:79-93. [PMID: 15204803 DOI: 10.1080/10673220490447191] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
My objective is to examine systematically the status of the current evidence for and against depression as an independent major risk factor for coronary disease. From English-language reports on depression and coronary disease in MEDLINE (1966-2002) and PsycINFO (1967-2002), and from informal searches, I selected all studies that addressed the specific questions related to the established criteria for risk-factor status: (1) strength of association, (2) prediction, (3) specificity, (4) consistency, (5) dose-response effect, (6) biological plausibility, and (7) response to treatment. I find that the evidence for depression as a coronary disease risk factor is good for four criteria: strength of association, prediction, consistency, and dose-response effect. The evidence on specificity and biological plausibility is fair. Due to the lack of definitive studies, there is currently insufficient evidence for cardiac risk reduction in response to treatment for depression. My conclusion is that the evidence for depression's role as an independent major risk factor for coronary disease is good in four areas, but not yet conclusive in three, pointing to the need for three types of studies: (1) prospective, observational studies that address specificity questions, (2) studies of biological mechanisms linking depression and coronary disease, and (3) clinical trials of treatments for depression in people with coronary disease or at high risk for developing coronary disease.
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Affiliation(s)
- Lawson R Wulsin
- Department of Psychiatry, University of Cincinnati College of Medicine, Ohio, USA.
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Abstract
This article reviews the epidemiology of comorbid coronary artery disease and unipolar depression. Both major depression and subsyndromal depressive symptoms will be considered; unless otherwise specified, the term depression will be used to designate all depressive states, including major depressive disorder, minor depression, dysthymia, and other subsyndromal forms of depression. While 17% to 27% of patients with coronary artery disease have major depression, a significantly larger percentage has subsyndromal symptoms of depression. Patients with coronary artery disease and depression have a twofold to threefold increased risk of future cardiac events compared to patients without depression, independent of baseline cardiac dysfunction. The relative risk for the development of coronary artery disease conferred by depression in patients initially free of clinical cardiac disease is approximately 1.5, independent of other known risk factors for coronary disease. In the discussion, special attention will be paid to the interactions of both gender and age with depression and coronary artery disease risk. Scrutiny of the role of confounding risk factors is presented, such as global burden of comorbid medical illness and modification of traditional risk factors, which may, in part, mediate the effect of depression on coronary artery disease.
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Affiliation(s)
- Bruce Rudisch
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia 30322, USA
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