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Effects of depressive disorders on coronary artery disease: a review
1Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle 98195-6560, USA.
Insights
Major depression and ischemic heart disease frequently coexist. Treating depression in heart disease patients can improve cardiovascular outcomes and reduce mortality rates.
Area of Science:
- Cardiology
- Psychiatry
- Epidemiology
Background:
- Major depression and ischemic heart disease (IHD) frequently co-occur.
- Depressive symptoms negatively impact cardiovascular prognosis.
- The association between depressive disorders and coronary artery disease (CAD) is a significant public health concern.
Purpose of the Study:
- To systematically review the literature on the association between depressive disorders and coronary artery disease.
- To evaluate the strength of evidence for this association using epidemiologic criteria.
- To highlight the clinical implications of comorbid depression in CAD patients.
Main Methods:
- A comprehensive Medline search was conducted for articles published between 1966 and 1996.
- Systematic epidemiologic criteria were applied to assess the strength of the association.
- Included studies focused on the relationship between depressive disorders and coronary artery disease.
Main Results:
- Convincing evidence demonstrates that depressive disorders are common in patients with CAD.
- Comorbid depression is associated with increased rates of morbidity and mortality in CAD patients.
- Proposed biological mechanisms include autonomic dysfunction and increased risk of ventricular arrhythmias.
Conclusions:
- Depressive disorders are a significant comorbidity in patients with coronary artery disease, linked to worse outcomes.
- Despite strong evidence, depression in CAD patients is often underdiagnosed and undertreated.
- Randomized treatment trials are warranted to investigate the benefits of treating depression in this population.
Abstract:
Evidence suggests that major depression and ischemic heart disease commonly co-occur and that depressive symptoms have a negative impact on cardiovascular prognosis. A Medline search was conducted to obtain articles published between 1966 and 1996 that address the association between depressive disorders and coronary artery disease. We used systematic epidemiologic criteria to examine the strength of this association. There is convincing evidence that in patients with coronary artery disease, depressive disorders are common and are associated with increased rates of morbidity and mortality. Several biological mechanisms have been proposed to explain the association, including alterations in autonomic function leading to increased risk of ventricular arrhythmias. Despite the evidence that their comorbid presence is associated with increased morbidity and mortality, depressive disorders in patients with coronary artery disease are often underdiagnosed and inadequately treated. At the very least, randomized treatment trials are indicated.