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Treating depression in patients with cardiovascular disease
1McLean Hospital, Belmont, Mass 02178, USA.
Insights
Depression increases cardiovascular mortality and worsens cardiac outcomes after myocardial infarction. Simultaneous treatment is challenging due to the interplay between these conditions, requiring careful consideration of cardiovascular effects of depression and treatments.
Area of Science:
- Cardiology
- Psychiatry
- Psychosomatic Medicine
Background:
- Cardiovascular disease (CVD) and depression are closely linked, with higher mortality rates in depressed individuals.
- Depression following myocardial infarction (MI) significantly worsens cardiac prognosis.
- Simultaneous management of CVD and depression presents challenges due to their complex interactions.
Purpose of the Study:
- To examine the evidence linking depression to cardiovascular effects.
- To explore proposed mechanisms underlying these cardiovascular effects of depression.
- To review the cardiovascular impact of antidepressant therapies and the psychological effects of cardiovascular medications.
Main Methods:
- Systematic review of English-language articles.
- Medline search conducted for articles published between 1970 and 1998.
- Keywords included: cardiovascular disease, antidepressants, psychiatry, myocardial infarction, antihypertensive agents, depression.
Main Results:
- Evidence supports a significant relationship between depression and adverse cardiovascular outcomes.
- Mechanisms linking depression to CVD are explored, including physiological and behavioral pathways.
- Cardiovascular effects of common antidepressants and mood-altering effects of cardiovascular drugs are reviewed.
Conclusions:
- The interplay between depression and cardiovascular disease necessitates a comprehensive understanding for effective treatment.
- Further research is needed to optimize simultaneous treatment strategies for patients with comorbid depression and CVD.
- Clinicians must consider the bidirectional effects when managing patients with both conditions.
Abstract:
Cardiovascular disease and depression are intimately related illnesses. Cardiovascular mortality is more common in persons with depression, and depression following a myocardial infarction is associated with significantly poorer cardiac outcome. Safe and effective simultaneous treatment of depression and cardiovascular illness can be difficult because of the interplay between these conditions. We examine the evidence for cardiovascular effects of depression, as well as the proposed mechanism for these effects. We also review the cardiovascular effects of antidepressant treatments and the mood-altering effects of common cardiovascular medications. Articles reviewed were derived from a Medline search of English-language articles published between 1970 and 1998 (search terms: cardiovascular disease, antidepressants, psychiatry, myocardial infarction, antihypertensive agents, depression).