Depressive Symptoms in Pulmonary Arterial Hypertension: Prevalence and Association With Functional Status

McCollister, Deborah H.; Beutz, Michelle; McLaughlin, Vallerie V.; Rumsfeld, John S.; Masoudi, Frederick A.; Tripputi, Mark; Yaeger, Thomas; Weintraub, Philippe; Badesch, David B.

doi:10.1016/s0033-3182(10)70706-4

Cited by 63 publications

(48 citation statements)

References 42 publications

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“…22 In addition, a previous study using a validated tool to assess the prevalence of depressive symptoms in PAH found that 15% and 55% of patients with PAH have symptoms suggestive of major depressive disorder and depression, respectively. 28 We were surprised to fi nd that clinical depression was reported in only approximately 40% of SSRI users in the present study, raising the possibility that depression was underreported. Furthermore, SSRI use was more prevalent in white than in nonwhite women, which is consistent with patterns of SSRI use in non-PAH populations in the United States.…”

Section: Unadjusted Outcomes: Mortality and Composite End Pointcontrasting

confidence: 67%

“…See Table 1 with symptoms suggestive of major depression. 28 However, our data demonstrate that pulmonary hemodynamics were comparable between SSRI users and nonusers in the incident use analysis. In the prevalent use analysis, PCWP was only slightly higher among high-affi nity SSRI users compared with nonusers, and this difference is not considered clinically relevant.…”

Section: Unadjusted Outcomes: Mortality and Composite End Pointmentioning

confidence: 56%

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Use of Selective Serotonin Reuptake Inhibitors and Outcomes in Pulmonary Arterial Hypertension

Sadoughi

Roberts

Preston

et al. 2013

Chest

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531T he serotonin hypothesis of pulmonary arterial hypertension (PAH) emerged . 40 years ago and was reemphasized in the 1990s following the association of pulmonary hypertension (PH) 1 with anorexic agents such as aminorex fumarate and fenfl uramine. [2][3][4][5] Serotonin promotes pulmonary arterial smooth muscle cell and fi broblast proliferation, pulmonary arterial vasoconstriction, and local microthrombosis-all key pathogenic features in PAH. These effects of serotonin are mediated by interactions between serotonin and its transporter and receptors. [6][7][8][9][10] In particular, the serotonin transporter (SERT) plays a key role in the pathogenesis of experimental PH; in animal models, SERT overexpression predisposes to the development of PH, whereas pharmacologic blockade of SERT is protective. 1,[11][12][13][14] In humans, a functional polymorphism in the SERT gene correlates with more severe PH associated with COPD. 15 Selective serotonin reuptake inhibitors (SSRIs) act via blockade of SERT, resulting in an extracellular accumulation of serotonin and increased activation of serotonin receptors. 16 SSRIs have been associated with both protection against and regression of PH in animal models, suggesting a possible role in the treatment of PAH in humans. 1,14,17 Early observational studies have suggested therapeutic effi cacy of SSRIs in patients with Background: Selective serotonin reuptake inhibitors (SSRIs) have been suggested to offer therapeutic benefi t in patients with pulmonary arterial hypertension (PAH). We conducted two analyses to explore the association between SSRI use and PAH outcomes using the Registry to Evaluate Early and Long-term PAH Disease Management (REVEAL Registry). Methods: First, new users (SSRI-naive patients who initiated treatment after enrollment, incident use analysis, n 5 220) were matched (1:2) with non-SSRI users (nonusers, n 5 440) by enrollment center, sex, date of most recent visit, age, and 6-min walk distance. Second, a cross-sectional design was used to compare nonusers (n 5 2,463), high-affi nity SSRI users (n 5 430), and non-high-affi nity SSRI users (n 5 125) at enrollment. Mortality and a composite end point defi ned by events indicative of clinical worsening were evaluated. Results: New users had a higher risk of death (unadjusted hazard ratio [HR], 1.74; 95% CI, 1.19-2.54; P 5 .004) and were less likely to be free from the composite end point 2 years after enrollment vs nonusers (25.7% vs 43.2%, respectively; P , .001). Similarly, among prevalent SSRI users (patients with a history of SSRI use at enrollment), high-affi nity SSRI users were less likely to be free from the composite end point vs nonusers (unadjusted HR, 1.20; 95% CI, 1.07-1.36; P 5 .003). In both analyses, differences in outcome were maintained after adjustment for clinical variables previously associated with PAH outcomes. Conclusions:In a large population of patients with PAH, incident SSRI use was associated with increased mortality and a greater risk of clinical worsening, although we could ...

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Section: Unadjusted Outcomes: Mortality and Composite End Pointcontrasting

confidence: 67%

Section: Unadjusted Outcomes: Mortality and Composite End Pointmentioning

confidence: 56%

Use of Selective Serotonin Reuptake Inhibitors and Outcomes in Pulmonary Arterial Hypertension

Sadoughi

Roberts

Preston

et al. 2013

Chest

Self Cite

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“…A recent study performed at two large PAH referral centres has shown that depression is common in PAH patients, with 55% of PAH patients demonstrating depressive symptoms (11). This study utilised a simple and well‐validated instrument, the Patient Health Questionnaire‐8 (PHQ‐8) (12), to determine the prevalence and severity of depressive symptoms in patients with PAH.…”

Section: Frequency Of Depression As a Comorbid Illness In Pahmentioning

confidence: 99%

“…Without a plan for screening and referral, depression may be under‐diagnosed and undertreated by PAH providers. Our recent study (11) found that 69% of patients with mild‐to‐moderate depressive symptoms were not on antidepressant therapy, and 50% of patients with severe depressive symptoms were not taking an antidepressant. Patients who are emotionally distressed may choose not to seek help for fear of stigmatisation, or they may wish to attempt to solve the problem on their own.…”

Section: The Use Of a Screening Instrument For Detection Of Depressivmentioning

confidence: 99%

Screening pulmonary hypertension patients for depression

McCollister¹

2011

International Journal of Clinical Practice

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“…Reported rates were between 20% and 40% for anxiety [9][10][11] and between 21% and 55% for depression [9,[11][12][13][14], with the exception of one study that reported a lower rate of 8% [10]. Moreover, neuropsychological tests identified cognitive sequelae in 59% of PAH patients, most frequently impairments in motor function (57%) and memory (41%) [11].…”

Section: Introductionmentioning

confidence: 99%

Understanding the impact of pulmonary arterial hypertension on patients' and carers' lives

Guillevin¹,

Armstrong²,

Aldrighetti³

et al. 2013

European Respiratory Review

129

214

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Pulmonary arterial hypertension (PAH) is a rare, debilitating and rapidly progressive disease. Although there have been important medical advances in PAH management, the search for a cure continues. Despite an increased understanding of the disease, data on the wider effect of PAH on patients and carers, beyond the clinical symptoms, are still limited. In order to explore this, a large-scale international survey investigated four key areas affected by PAH (physical and practical, emotional, social, and information needs) and provides new insight into patients' and carers' experiences of living with the disease. The results from the survey highlight not only the limited ability of patients to carry out everyday tasks, but also the financial impact and social isolation experienced by both patients and carers. The study confirmed that a decline in a patient's World Health Organization functional class, which indicates an increase in clinical severity of the disease, is associated with greater limitations. Results from the survey demonstrate the need for multidisciplinary PAH management and a comprehensive standard of care to assess and improve all aspects of well-being for both patients and carers. In addition, they underline the need for updated PAH guidelines that address these needs. @ERSpublications PAH has a profound impact on numerous aspects of patients' and carers' lives http://ow.ly/pWWYf This article has supplementary material available from err.ersjournals.comFull survey results, along with a call to action, are available at www.phaeurope.org/projects-activities/pah-patient-andcarer-survey

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Depressive Symptoms in Pulmonary Arterial Hypertension: Prevalence and Association With Functional Status

Cited by 63 publications

References 42 publications

Use of Selective Serotonin Reuptake Inhibitors and Outcomes in Pulmonary Arterial Hypertension

Use of Selective Serotonin Reuptake Inhibitors and Outcomes in Pulmonary Arterial Hypertension

Screening pulmonary hypertension patients for depression

Understanding the impact of pulmonary arterial hypertension on patients' and carers' lives

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