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Pathophysiological basis of cardiovascular disease and depression: a chicken-and-egg dilemma
Gilberto Paz-Filho1, Julio Licinio, Ma-Li Wong
1The John Curtin School of Medical Research, Australian National University, Canberra, Australia.
Insights
Cardiovascular disease (CVD) and depression share common causes and are closely linked. Antidepressant choice matters; tricyclics may worsen cardiac outcomes, unlike selective serotonin reuptake inhibitors.
Area of Science:
- Cardiology
- Psychiatry
- Pathophysiology
Background:
- Cardiovascular disease (CVD) and depression are prevalent conditions with significant overlap.
- Shared pathophysiological mechanisms link these two conditions, including hypothalamic-pituitary axis alterations, cardiac rhythm disturbances, and changes in hemostasis, inflammation, and serotonin pathways.
Purpose of the Study:
- To elucidate the pathophysiological basis connecting CVD and depression.
- To examine the causal relationship between depression and CVD.
- To review the impact of antidepressant therapies on cardiovascular health.
Main Methods:
- Literature review utilizing the PubMed database.
Main Results:
- Tricyclic antidepressants are associated with adverse cardiac outcomes.
- Selective serotonin reuptake inhibitors do not appear to carry the same cardiac risks.
Conclusions:
- The exact causal link between depression and CVD remains uncertain; they may share etiologies or influence each other.
- Concomitant treatment of both depression and CVD is essential.
- Non-tricyclic antidepressants are preferred for treating depression in patients with CVD.
Objective:
To describe the pathophysiological basis linking cardiovascular disease (CVD) and depression; to discuss the causal relationship between them, and to review the effects of antidepressant treatment on cardiovascular disease.
Method:
A review of the literature based on the PubMed database.
Discussion:
Depression and cardiovascular disease are both highly prevalent. Several studies have shown that the two are closely related. They share common pathophysiological etiologies or co-morbidities, such as alterations in the hypothalamic-pituitary axis, cardiac rhythm disturbances, and hemorheologic, inflammatory and serotoninergic changes. Furthermore, antidepressant treatment is associated with worse cardiac outcomes (in case of tricyclics), which are not observed with selective serotonin reuptake inhibitors.
Conclusion:
Although there is a strong association between depression and cardiovascular disease, it is still unclear whether depression is actually a causal factor for CVD, or is a mere consequence, or whether both conditions share a common pathophysiological etiology. Nevertheless, both conditions must be treated concomitantly. Drugs other than tricyclics must be used, when needed, to treat the underlying depression and not as mere prophylactic of cardiac outcomes.
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