Depression and heart failure: the lonely comorbidity

Abstract

Depression is a frequent and debilitating comorbidity that affects heart failure (HF) patients. Up to 30% of HF patients suffer from depression and even more have depressive symptoms. Moreover, depression carries a risk for HF, especially in high‐risk groups, and is significantly associated with worse quality of life and clinical outcomes. The pathophysiology of depression and HF is poorly understood, but both diseases share several mechanisms and risk factors, including dysregulation of platelet reactivity, inflammation, neuroendocrine function, arrhythmias, high‐risk behaviours, and social factors. Current HF guidelines advise to screen HF patients for depression and several screening questionnaires are available. Ultimately, the diagnosis of depression is based on DSM‐5 criteria. Depression treatment consists of non‐pharmacological and pharmacological therapies. Non‐pharmacological therapies, such as exercise training and cognitive‐behavioural therapy, have been shown to have beneficial effects on depressive symptoms. Selective serotonin reuptake inhibitors, the mainstay of antidepressant therapy, appear to be safe in HF but have not shown superiority over placebo in HF in short‐ and long‐term randomized clinical trials. New therapies to treat depression are under investigation and may offer the opportunity to improve depression management in HF, including N‐methyl‐D‐aspartate receptor antagonists, repetitive transcranial magnetic stimulation and omega‐3 supplementation. New technologies may offer several advantages for the screening and diagnosis of depression but they remain to be tested in future research. In this review, we examine the intersection of depression and HF, summarize the epidemiology and pathophysiology, and discuss new opportunities to diagnose and treat HF patients with depression.

Major depression and clinical outcomes in patients with heart failure with preserved ejection fraction

“…Several biological mechanisms have been proposed to explain the worse prognosis of patients with depression and HFrEF, including lifestyle factors, inflammation, autonomic dysfunction, neuroendocrine imbalance and platelet reactivity. The majority of previous studies on depression were conducted in patients with HFrEF, showing that depression is associated with worse clinical status and poor prognosis 35 . Kato et al demonstrated that increased symptoms of depression were associated with an increased risk of adverse cardiac events, independent of HF severity in HFpEF patients 28 .…”

Self‐care of heart failure patients: practical management recommendations from the Heart Failure Association of the European Society of Cardiology

“…Antidepressants are safe in patients with HF and are not associated with increased mortality. However, there is inadequate evidence that the use of antidepressants effects significant improvement in depression or cardiac outcomes 56,57 Interventions, such as Tai‐Chi, yoga, meditation, relaxation, and stress management may improve quality of life and psychological status 58–60 .…”

Can selective serotonin reuptake inhibitors have a neuroprotective effect during COVID-19?

“…Moreover, it is well-known that 5-HT is effective not only to treat depression but also to decrease the susceptibility to depression and suicide ( Li and He, 2007 ). Interestingly, stimulation of the serotonergic pathway is thought to be so beneficial that the use of non-pharmacological methods to increase 5-HT levels have been suggested as a potential strategies to prevent depression and/or improve mood and social functioning, by means of exercise ( Sbolli et al, 2020 ) or exposure to bright light ( Harrison et al, 2015 ), for instance.…”