Is Depression the Wrong Treatment Target for Improving Outcome in Coronary Artery Disease?

Affective Temperaments Contribute to Cardiac Complications in Hypertension Independently of Depression

“…Our results support the proposal of Rafanelli et al [1] to consider personality as marker for a higher cardiovascular disorder risk and carry additional information as affective temperaments represent the biologically stable core of personality determining its emotional domain [9]. Moreover, cyclothymic temperament with rapid cycles of hyperthymic and depressive episodes as main characteristic [10] is the precursor of bipolar disorder often with earlier onset, atypical features, more relapses and worse prognosis [9,10], forming the basis of therapy resistance leading to cardiovascular complications as well [9,10].…”

“…Recently Rafanelli et al [1] provided a detailed summary of research efforts to improve cardiac morbidity and mortality by treating concurrent depression. They found that antidepressant treatment is more effective on cardiac end points in severe depression; however, mild depressive symptoms without major depressive disorder also increase the cardiovascular risk.…”

“…It was also revealed that antidepressant treatment does not result in significant cardiovascular improvement in the subpopulation of cardiac patients refractory to dose increase, those with relapses after long-term antidepressant use and those with bipolar disorder. A type A behavioural pattern - as well as cyclothymic disorder [2] - is a subclinical manifestation of bipolar illness, and mood improvement of depressed patients in this group may result in hypomania [1], leading to extreme behavioural changes detrimental to cardiac prognosis [1]. To further characterize this most vulnerable group, based upon the suggestion of Rafanelli et al [1], we examined the affective temperamental traits (Temperament Evaluation of Memphis, Pisa, Paris and San Diego Autoquestionnaire, TEMPS-A [3,4]) on depressive, cyclothymic, hyperthymic, irritable and anxious subscales, ICD-10-diagnosed depression and depressive symptoms (Beck Depression Inventory, BDI [5,6]) in relation to cardiac complications (CC) requiring acute hospitalization (acute coronary syndrome, acute myocardial infarction) in a primary hypertensive outpatient population.…”

Psychosomatics: Past, Present and Future

“…The ENRICH D study that attempted to use cognitive behavioral therapy for cardiac patients who were depressed or socially isolated found improvement in quality of life but not mortality rates. Rafanelli et al [69] discussed data from a variety of similar studies and suggests that investigators are perhaps looking at the wrong variables for such outcomes but may wish to consider personality factors such as type A characteristics. In another disease state, i.e.…”

Clinical Factor 2013

“…Finally, Rafanelli et al [30], in an editorial in this journal, questioned the massive use of antidepressants in the cardiology setting. They noted that antidepressants have a modest effect in improving depression and lack an effect on cardiovascular prognosis in coronary artery disease (CAD) patients.…”