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An Unpredictable Chronic Mild Stress Protocol for Instigating Depressive Symptoms, Behavioral Changes and Negative Health Outcomes in Rodents
Published on: December 2, 2015
Depression and heart disease: therapeutic implications
Trudie C Somberg1, Rohit R Arora
1George Washington University, Washington, DC, USA.
Insights
Depression and coronary artery disease (CAD) comorbidity increases cardiovascular mortality. Selective serotonin reuptake inhibitors (SSRIs) may reduce this risk by improving platelet function in depressed patients with CAD.
Area of Science:
- Cardiology
- Psychiatry
- Pharmacology
Background:
- Comorbidity of depression and coronary artery disease (CAD) is linked to increased cardiovascular mortality.
- Existing treatments for depression may exacerbate cardiac issues or be poorly tolerated by CAD patients.
Purpose of the Study:
- To review literature on the link between depression and CAD.
- To explore mechanisms underlying the increased cardiovascular mortality in patients with both conditions.
- To evaluate the potential benefits of selective serotonin reuptake inhibitors (SSRIs) in this population.
Main Methods:
- Literature review of studies examining depression and CAD.
- Analysis of potential pathophysiological links, including medication side effects and platelet abnormalities.
- Examination of findings from trials like SADHART and ENRICHD regarding SSRI use.
Main Results:
- Tricyclic antidepressants can cause cardiac arrhythmias.
- Serotonin abnormalities in platelets may contribute to both depression and increased platelet aggregation.
- Vascular depression due to atherosclerosis is another potential mechanism.
- Depressed patients may exhibit lower medication compliance.
- SSRIs may reduce cardiovascular mortality in depressed patients, potentially by addressing platelet abnormalities.
Conclusions:
- The comorbidity of depression and CAD presents significant cardiovascular risks.
- SSRIs show promise in mitigating cardiovascular mortality in depressed CAD patients, possibly through effects on platelet serotonin.
- Further research into SSRI mechanisms for treating comorbid depression and CAD is warranted.
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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