Cardiovascular Abnormalities in Patients with Major Depressive Disorder

Abstract

This article provides a detailed review of the association of major depression with coronary heart disease (CHD), examines the biological variables underpinning the linkage and discusses the clinical implications for treatment. When considering the co-morbidity between major depressive disorder (MDD) and CHD it is important to differentiate between (i) the prevalence and impact of MDD in those with existing CHD and (ii) MDD as a risk factor for the development of CHD. Whether the same biological mechanisms are at play in these two instances remains unknown. Depression is common in patients with CHD. Importantly, depression in these patients increases mortality. There is also consistent evidence that MDD is a risk factor for the development of CHD. The relative risk of developing CHD is proportional to the severity of depression and is independent of smoking, obesity, hypercholesterolaemia, diabetes mellitus and hypertension. There is a clear need to identify the underlying neurochemical mechanisms responsible for MDD and their linkage to the heart and vascular system. Of particular interest are activation of stress pathways, including both the sympathetic nervous system and hypothalamic-pituitary-adrenal axis, and inflammatory-mediated atherogenesis. Elevated sympathetic activity, reduced heart rate variability and increased plasma cortisol levels have been documented in patients with MDD. In addition to direct effects on the heart and vasculature, activation of stress pathways may also be associated with increased release of inflammatory cytokines such as interleukin-6 and tumour necrosis factor-alpha. Elevated levels of C-reactive protein are commonly observed in patients with MDD. The majority of investigations examining treatment of depression following myocardial infarction have focused on safety and efficacy; there is little evidence to indicate that treating depression in these patients improves survival. Given that strategies for preventive therapy remain incompletely formulated, future research should focus on generating a better understanding of the neurobiology of MDD and heart disease as a basis for rational and effective therapy.

Comorbidity Profile and Healthcare Utilization in Elderly Patients with Serious Mental Illnesses

“…When the comorbidity comparisons involve the three seriously mentally ill diagnostic groups separately (bipolar illness, schizophrenia and major depressive disorder) all three groups have lower rates of hypertension and higher rates of falls than the primary care controls. Within the mental illness diagnostic groups patients with major depressive disorders had higher rates of congestive heart failure, coronary artery disease and stroke than did the other two groups (10). …”

“…This discrepancy is at least in part generally explained as being caused by increases in comorbid medical conditions in the mentally ill, particularly chronic illnesses such as diabetes (6–9) and cardiovascular disease (2, 10–14). To alleviate these problems there have been reports of clinical interventions to improve health care in the seriously mentally ill with some success (15, 16).…”

Describing the population health burden of depression: health-adjusted life expectancy by depression status in Canada

“…3 Depression has an important impact on health-related quality of life (HRQOL), functioning, mortality due to intentional injury and health care utilization. [4][5][6] In addition to these direct negative outcomes, depression has also been demonstrated to increase risk for coronary heart disease, 7 stroke 8 and cancer 9 and a decline in physical functioning. 10 Potential mechanisms for the relationship between depression and physical disease include immune and endocrine dysregulation and inflammatory processes.…”

Description du fardeau de la dépression sur la santé de la population au Canada : utilisation de l’espérance de vie ajustée en fonction de la santé

“…La dépression a un impact sur la qualité de vie liée à la santé (QVLS), les capacités fonctionnelles, la mortalité due à une blessure intentionnelle et l'utilisation des soins de santé [4][5][6] . Il a également été prouvé, outre ces effets négatifs directs, que la dépression augmente le risque de coronaropathie 7 , d'accident vasculaire cérébral 8 et de cancer 9 , ainsi qu'un déclin du fonctionnement physique 10 . Les mécanismes potentiels de la relation entre la dépression et la maladie physique relèvent notamment du dérèglement des systèmes immunitaire et endocrinien et des processus inflammatoires 11 .…”