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Brain mechanisms of stress and depression in coronary artery disease
J Douglas Bremner1, Carolina Campanella2, Zehra Khan2
1Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA; Department of Radiology, and Internal Medicine (Cardiology), Emory University School of Medicine, Atlanta, GA, USA; Atlanta VA Medical Center, Decatur, GA, USA.
Insights
Major depression increases coronary artery disease (CAD) risk. This study found depressed CAD patients exhibit altered brain activity during stress, particularly in areas linked to depression and stress response, explaining increased cardiac risk.
Area of Science:
- Cardiology
- Neuroscience
- Psychiatry
Background:
- Major depression is a known risk factor for coronary artery disease (CAD) morbidity and mortality.
- The underlying mechanisms linking depression, stress, and cardiovascular risk remain unclear.
- Brain regions involved in memory and stress response are altered in depression and may influence cardiovascular health.
Purpose of the Study:
- To investigate the effects of mental stress on brain and cardiac function in patients with CAD.
- To compare these effects between CAD patients with and without major depression.
Main Methods:
- Coronary artery disease (CAD) patients with (N=17) and without (N=21) major depression were recruited.
- Brain imaging utilized high-resolution positron emission tomography (HR-PET) with [O-15] water.
- Cardiac imaging employed single-photon emission tomography (SPECT) with [Tc-99m] sestamibi during mental stress and control conditions.
Main Results:
- Patients with CAD and major depression showed increased parietal cortex activation during mental stress.
- A relative failure of medial prefrontal/anterior cingulate activation was observed in depressed CAD patients.
- Depressed CAD patients with stress-induced myocardial ischemia exhibited increased activation in rostral anterior cingulate regions.
Conclusions:
- Brain regions associated with stress and depression play a role in the elevated risk of CAD morbidity and mortality in depressed patients.
- Altered brain activation patterns during stress in depressed CAD patients may mediate cardiovascular risk.
Introduction:
Major depression is associated with an increased risk for and mortality from coronary artery disease (CAD), however the mechanisms by which this occurs are not clear. Depression, which is linked to stress, is associated with changes in brain areas involved in memory and the stress response, and it is likely that these regions play an important role in this increased risk. This study assessed the effects of stress on brain and cardiac function in patients with CAD with and without depression.
Methods:
CAD patients with (N = 17) and without (N = 21) major depression based on the Structured Clinical Interview for DSM-IV (DSM-IV) and/or a Hamilton Depression Scale score of nine or greater underwent imaging of the brain with high resolution positron emission tomography (HR-PET) and [O-15] water and imaging of the heart with single photon emission tomography (SPECT) and [Tc-99 m] sestamibi during mental stress (mental arithmetic) and control conditions.
Results:
Patients with CAD and major depression showed increased parietal cortex activation and a relative failure of medial prefrontal/anterior cingulate activation during mental stress compared to CAD patients without depression. Depressed CAD patients with stress-induced myocardial ischemia, however, when compared to depressed CAD patients without showed increased activation in rostral portions of the anterior cingulate.
Conclusions:
These findings are consistent with a role for brain areas implicated in stress and depression in the mechanism of increased risk for CAD morbidity and mortality in CAD patients with the diagnosis of major depression.
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