Electroconvulsive therapy and the heart

Solimene, Maria Cecilia

doi:10.1016/j.ijcard.2005.09.053

Cited by 4 publications

(3 citation statements)

References 4 publications

(10 reference statements)

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“…In addition, electroconvulsive therapy can lead to elevations in blood pressure and heart rate, transient arrhythmias, and decreases in LVEF in healthy subjects. [80][81][82] The Identifying Depression as a Comorbid Condition (IDACC) trial was a large randomized study that did not examine the impact of medical or psychologic therapy, but rather a patientspecific case management approach to caring for depressed patients with cardiac disease. 74,83 Hospitalized patients with cardiac disease (72% had acute coronary syndrome) and depression as identified by the Center for Epidemiologic Studies-Depression (CES-D) survey were randomly assigned to intervention (331 patients) or usual care (338 patients).…”

Section: Other Nonpharmacologic Interventions For Depressionmentioning

confidence: 99%

Impact and Clinical Management of Depression in Patients with Coronary Artery Disease

2010

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The rates of major adverse coronary events, including recurrent ischemic events and death, in patients with coronary artery disease (CAD) have been shown to be significantly increased in patients with depression. In addition, health care costs are higher and health-related quality of life is lower in depressed patients with CAD. Several pathophysiologic mechanisms have been proposed for the association of increased events seen in this population. Studies have focused on antidepressants (specifically, selective serotonin reuptake inhibitors and mirtazapine), psychotherapy (cognitive behavioral therapy and interpersonal psychotherapy), and a wide range of other nonpharmacologic interventions. Pharmacologic and nonpharmacologic treatments are known to improve depressive symptoms in patients with CAD, but their effects on outcomes such as mortality and hospital admissions remain controversial. If treatment of depression is warranted, strategies should include sertraline or citalopram, with or without cognitive behavioral therapy, based on the known efficacy and safety of the drugs in this population. Nonpharmacologic therapy such as aerobic exercise has been shown to improve not only depression but also cardiovascular health. When selecting an appropriate antidepressant, clinicians should consider their patients' comorbid conditions and the potential for drug interactions, and treatment should be frequently monitored. Screening for depression in patients with cardiac disease should be instituted on a routine basis by using either case-finding or symptom-triggered approaches. Based on the high prevalence of depression and its known adverse effects in patients with CAD, future research is needed to help determine the role of antidepressants and nonpharmacologic strategies in improving outcomes in patients with both comorbidities.

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Section: Other Nonpharmacologic Interventions For Depressionmentioning

confidence: 99%

Impact and Clinical Management of Depression in Patients with Coronary Artery Disease

2010

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“…65 Its potential benefit, however, must be tempered by the knowledge of a rare but real risk of cardiovascular-related death, as well as demonstrated elevations in blood pressure and heart rate and decreases in LVEF after therapy in patients without cardiac conditions. 66,67…”

Section: Safety Of Antidepressantsmentioning

confidence: 99%

Depression in Patients with Heart Failure: Clinical Implications and Management

Watson

Summers

2009

Pharmacotherapy

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Mortality and morbidity rates remain high in patients with heart failure despite advances in medical therapy. Heart failure can also significantly worsen quality of life. Attention has been paid to evaluating the effects of psychological disease in patients with heart failure. Depression rates are higher in patients with heart failure than in the general population. Depression has been associated with worse outcomes in patients with heart failure. Those at highest risk for depression include patients with implantable cardioverter-defibrillators, alcohol abuse, history of depression, and multiple comorbidities. Depression may be underdiagnosed in the heart failure population, as symptoms can often be similar in the two disease states. Evidence is limited on the effects of pharmacologic and nonpharmacologic therapy for depression, specifically in patients with heart failure. Based on the available literature, patients with heart failure should be screened routinely for depression. Treatment is known to improve quality of life, but its effect on outcomes such as mortality and hospital admissions for heart failure remains unknown. If treatment includes pharmacologic strategies, selective serotonin reuptake inhibitors (especially paroxetine and sertraline), mirtazapine, and nefazodone have the strongest efficacy evidence in this population. Based on safety data of these agents and after consideration of comorbid conditions and the potential for drug interactions, a selective serotonin reuptake inhibitor should be used as first-line therapy. Finally, clinicians should not avoid beta-blockers in those with a diagnosis of depression, as recent evidence demonstrates that these agents are not associated with inducing or worsening depressive symptoms.

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“…Electroconvulsive therapy is associated with transient bradycardia followed by sustained elevations in heart rate and blood pressure, which are more prolonged in those over age 55 than in younger individuals [39]. Case reports and clinical series have described successful ECT in patients shortly after acute myocardial infarction, in patients with impaired left ventricular function and cardiac conduction abnormalities, and in series of miscellaneous ''high cardiac risk'' patients [40][41][42][43][44].…”

Section: Electroconvulsive Therapymentioning

confidence: 99%

Treatment of depression in patients with congestive heart failure

Shapiro

2007

Heart Fail Rev

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Heart failure is common, and depression is common in heart failure patients, adding substantially to the burden of the disease. There is some evidence for the safe and at least modestly effective use of psychotherapy and antidepressants to treat depression in heart failure patients. Cognitive behavioral psychotherapy and selective serotonin reuptake inhibitors are first line treatments. The efficacy of depression treatment in altering cardiac outcomes in heart failure patients has yet to be established.

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Electroconvulsive therapy and the heart

Cited by 4 publications

References 4 publications

Impact and Clinical Management of Depression in Patients with Coronary Artery Disease

Impact and Clinical Management of Depression in Patients with Coronary Artery Disease

Depression in Patients with Heart Failure: Clinical Implications and Management

Treatment of depression in patients with congestive heart failure

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