Lower Frequency of Antidepressant Use in Patients on Renin-Angiotensin-Aldosterone System Modifying Medications

Abstract

Both hypertension and depression are common disorders which may both involve components of the hypothalamic-pituitary-adrenal axis system and the Renin-Angiotensin-Aldosterone System (RAAS). These observations, coupled with growing evidence that RAAS-active drugs may have anti-depressant properties prompted us to study the frequency of anti-depressant medication usage in the patients receiving RAAS-active agents. A chart review was performed on 378 patients who were seen during a 3-month period in a primary care clinic and who were diagnosed with hypertension. Demographic information and data on the rates of co-administration of antihypertensive and anti-depressant medications was collected. Overall, 23.7% of the sample was on an antidepressant. 20% of the patients taking a RAAS-modifying medication were on an antidepressant, compared to 34% of those not taking a RAAS-modifying medication (Χ(2) = 8.88, P = 0.003). The patients taking a beta-blocker alone had the highest rate of antidepressant usage (40%). The use of RAAS-modifying medications was associated with an even lower rate of anti-depressant usage in males compared with females. It was also observed that the patients taking an additional diuretic had a significantly lower rate of antidepressant use (17.6%, Χ(2) = 5.81, P = 0.016) compared with the patients not taking a diuretic. The patients being treated with an ACE inhibitor or ARB showed significantly lower rates of antidepressant usage. The data is supportive of the hypothesis that these agents may possess anti-depressant effects.

Angiotensin II AT1 Receptor Blockers Ameliorate Inflammatory Stress: A Beneficial Effect for the Treatment of Brain Disorders

“…ARBs have been reported to improve mood and the regulation of the HPA axis in diabetic patients (Pavlatou et al 2008). Depressed patients medicated with ARBs to treat co-morbid hypertension improve their response to and require lower doses of antidepressants to achieve therapeutic efficacy (Nasr et al 2011), and a similar finding was earlier reported in patients treated with inhibitors of Angiotensin II formation the Angiotensin Converting Enzyme inhibitors (ACEI) (Braszko et al 2003; Hertzman et al 2005). …”

Angiotensin II AT1 receptor blockers as treatments for inflammatory brain disorders

“…These effects occur not only in hypertensive subjects, but also in normotensive patients and in those affected with diabetes [5,179,222–229] (Table 1). This indicates that there appears to be a good correlation between the anti-stress, anti-anxiety, anti-depressant, anti-inflammatory and cerebrovascular-protective effects of ARBs, as revealed in rodent models and observational studies in humans.…”

Brain and retinal microglia in health and disease: An unrecognized target of the renin–angiotensin system

“…Although it has been established that AngII‐mediated AT 1 R signalling results in the activation of proinflammatory pathways in numerous cell types, including cardiac myocytes, vascular endothelial cells and neurons, the role of the RAS in microglial cell function is not as well understood. In terms of disorders of the CNS, blockade of the AT 1 R has been found to be beneficial in AD, in which disease progression was slowed in patients treated with an ARB, and depression, in which patients taking an ARB required a lower dose of antidepressant to achieve an efficacious response . These clinical findings are supported by animal studies showing reduced neuronal damage in animals treated with an ARB following experimentally induced AD, PD, traumatic head injury and stroke .…”