Treatment of affective disorders in cardiac disease
Nicole Mavrides1, Charles B Nemeroff1
1Department of Psychiatry and Behavioral Sciences, Center on Aging, University of Miami Miller School of Medicine, Miami, Florida, USA.
Insights
Major depression is common in cardiovascular disease (CVD) patients. Antidepressants, particularly SSRIs, are safe and effective for treating depression in CVD, though cardiac outcome impacts require further study.
Area of Science:
- Cardiology
- Psychiatry
- Clinical Trials
Background:
- Major depression is prevalent in cardiovascular disease (CVD) patients, ranging from 17% to 47%.
- Depression is linked to increased CVD morbidity and mortality.
- Physiological links, including inflammation and shared biological risks, connect major depressive disorder and CVD.
Purpose of the Study:
- To review the prevalence of depression in CVD patients.
- To explore physiological links between depression and CVD.
- To assess the efficacy and safety of treatments for depression in CVD patients.
Main Methods:
- Review of randomized controlled clinical trials.
- Analysis of evidence on pharmacologic and psychotherapeutic interventions.
- Examination of studies on potential mediators between major depressive disorder and CVD.
Main Results:
- Antidepressants, especially selective serotonin uptake inhibitors (SSRIs), are safe and likely effective for depression in CVD.
- Psychotherapeutic interventions are also generally safe and somewhat efficacious.
- The impact of these treatments on cardiac outcomes remains unclear.
Conclusions:
- Antidepressant medications and psychotherapy are viable treatment options for depression in CVD patients.
- Understanding of shared biological risks and health behaviors mediating depression and CVD has advanced.
- Further research is needed to clarify the impact of depression treatment on cardiac outcomes.
Abstract:
Patients with cardiovascular disease (CVD) commonly have syndromal major depression, and depression has been associated with an increased risk of morbidity and mortality. Prevalence of depression is between 17% and 47% in CVD patients. Pharmacologic and psychotherapeutic interventions have long been studied, and in general are safe and somewhat efficacious in decreasing depressive symptoms in patients with CVD. The impact on cardiac outcomes remains unclear. The evidence from randomized controlled clinical trials indicates that antidepressants, especially selective serotonin uptake inhibitors, are overwhelmingly safe, and likely to be effective in the treatment of depression in patients with CVD. This review describes the prevalence of depression in patients with CVD, the physiological links between depression and CVD, the treatment options for affective disorders, and the clinical trials that demonstrate efficacy and safety of antidepressant medications and psychotherapy in this patient population. Great progress has been made in understanding potential mediators between major depressive disorder and CVD--both health behaviors and shared biological risks such as inflammation.
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