Depression in cardiovascular disease
Depression and cardiovascular disease are interconnected in many ways, and are the most common diseases in the general population and various medical fields.
The comorbidity rate of the two is also very high, due to many accidental factors.
This is because patients with depression are significantly more likely to develop hypertension and / or hypertension and vice versa (Cunningham, 1994; Lane et al., 1994 Shapiro et al., 1997).
Physical symptoms (such as chest pain and palpitations) may be a prominent feature of some depressive disorders (üstün and Sartorius, 1995), which can cause misdiagnosis of the above.
When cardiovascular disease and depressive disorder occur simultaneously, residents can only diagnose and treat heart disease (Barsky, 1992; Tylee et al., 1993).
Both should actually be treated (see Chapter 3).
Cardiovascular disease as a risk factor for depressive disorders. The psychological response to cardiovascular disease (see Chapter 1) and the biological susceptibility to depressive disorders all lead to the occurrence or recurrence of depression.
For example, Carney et al. (1988) found that in patients with newly diagnosed coronary artery disease, 17% had major depressive disorder during coronary angiography, and further, patients with depression developed myocardial infarction in the next 12 monthsAnd are twice as likely to die as non-depressed patients.
Shapiro et al. (1997) found that major depressive disorder occurred in 16% -22% of patients after myocardial infarction.
Mood disorders significantly increase short-term and long-term deaths, mainly due to sudden cardiac death caused by arrhythmia.
Depression as a risk factor for morbidity and mortality in cardiovascular disease Many studies have pointed to increased cardiovascular morbidity and mortality in patients with depression: Avery and Winokur (1976) found that those who are not properly treated in the treatment of depressionMortality due to suicide and myocardial infarction is more common in people who get the right treatment.
Similar increases in risk have been reported in studies of patients with unipolar and bipolar depression (Sharma and Markar, 1994; Tsuang et al. 1980).
Lyness et al. (1993) found that out of 109 patients with major depressive disorder who were continuously hospitalized, 30% had hypertension, 12% had coronary artery disease, and 5% had congestive heart failure.
Patients with major depression or bipolar disorder have a 9% -27% higher prevalence of diabetes than the general population and other mental patients (Goodnick, 1997).
Other studies have found a link between smoking and depressive symptoms, assman, 1993).
This may be a common genetic susceptibility factor (Kendler et al., 1993).
Patients with diabetic depressive disorder have higher morbidity and mortality from cardiovascular disease, which may be due to their high rate of hypertension, diabetes and smoking-this is a factor infarction that is considered to be coronary artery disease and / or heartRisk factors.
Diagnosing patients with depression with somatic symptoms often overlook their experience as a heart disease, such as chest pain or prevention of complication, palpitations, shortness of breath, and apnea, although chest pain and palpitations are the firstThe most common symptom in diagnosis and cardiovascular medicine-also a common cause of extensive in-depth diagnostic tests (Alexander et al., 1994; Beitman et al., 1987; Potts and Bass, 1995), but in patients undergoing coronary angiography for chest painNormal or near-normal coronary arteries account for 10% -40%, 15% have panic disorder, and 27% have reported major depressive disorder (Potts and Bass et al., 1995).
Depression and cardiac surgery Among patients who have undergone coronary artery bypass grafting and heart transplantation, 40% -50% of patients have anxiety and depression symptoms before surgery.
Undetected depressive disorder significantly worsens the prognosis (Bass, 1984; Maj et al., 1993).
Because the diagnosis of preoperative psychiatric disease is closely related to poor adherence to surgery (Maj, 1993), the attending psychiatrist can often play an important role during cardiac surgery.
Unlike acute psychosis and irreversible organic brain injury, depression and anxiety disorders are not absolute contraindications to cardiac surgery. Before surgery, the successful treatment of anxiety and depression symptoms using drugs and psychotherapy can help patients prepare for surgery.
Initial regular follow-up can increase the chances of a successful recovery.
Psychological problems in heart transplantation differ from other cardiac surgeries in two ways: (1) the special psychological state caused by a new heart life, and (2) the need to perform a high degree of obedience to the medical team, especially during immunosuppressive periods.
Treatment options This section is about the treatment of depressive disorders with cardiovascular disease. See section 1 for general treatment.
Cardiovascular Drugs and Depressive Symptoms The following medications commonly used in the treatment of hypertension and other cardiovascular diseases can be accompanied by depressive symptoms or have an adverse interaction with a commonly used antidepressant.
Antihypertensive beta-blockers: Hydrophilic beta-blockers, such as atenolol and propenolol, cannot cross the blood-brain barrier as quickly as lipophilic drugs such as propranolol; therefore,May cause depressive symptoms (Yudofsky, 1992).
Although concomitant use of depression medications is generally safe, remember that TCA can weaken due to a common competition for adrenaline receptors?
Antihypertensive effect of blockers.
Other antihypertensive drugs: Evidence is uncertain about calcium channel blockers and depressive symptoms; some studies suggest that depressive symptoms can be a side effect of these drugs, and other studies have shown that these drugs can improve depressive symptoms.
A recent meta-analysis found that the use of calcium channel blockers has been linked to an increased risk of suicide (Lindberg, 1998).
ACE inhibitors also have side effects that induce symptoms of depression.
Case reports suggest that depression may be accompanied by the emergence of other antihypertensive drugs, such as brom benzylamine, malondiamine, prazosin, and procainamide, however, there is no systematic study of the link to this possibility(Levenson, 1993), the same situation is also seen?
Synergistic agent of 2-adrenergic receptor.
Finally, diuretics can cause resonance disorders, which can produce symptoms that reduce depression, especially in the elderly.
Cholesterol-lowering drugs have been shown to have depressive symptoms during the use of pravastatin and cholestyramine (Lechleitner et al., 1992).
This may be due to low serum hypertension and lower meningeal phospholipid viscosity.
This has led to a reduction in surface 5-HT receptor exposure (Engelberg, 1992). Anti-arrhythmic drugs William Withering dating digitalis to medical practice, initially described the drug’s association with depression.
When using digoxin, although depression, blind spots, and visual hallucinations are often seen, depression, fatigue, agitation, insomnia, and nightmares have also been described.
However, there is very little evidence that digitalis can produce significant depressive symptoms.
Depressive reactions with other antiarrhythmic drugs, such as lidocaine, procainamide, and quinidine, are rare; however, lidocaine and quinidine often cause concern and agitation (Levenson, 1993).
Drug treatment for depressive disorders in cardiovascular patients A variety of drugs are available for the treatment of depressive disorders in this case.
TCA and MAOIs have limited use in these populations.
Side effects include orthostatic hypotension, tachycardia, metabolic disorders, and arrhythmias.
These abnormalities can occur at both therapeutic doses and overdose (Glassman and Preud, homme, 1993; Hale, 1993; Lane et al., 1994).
SSRIs SSRIs and reversible MAOI (almost no cardiovascular side effects, can be used safely (Bernstein, 1995; Gattaz et al., 1995; Glassman and Preud, homme, 1993; Lane et al., 1994).
In the treatment of cardiovascular disease, the addition of SSRI can significantly improve depression and anxiety symptoms (Roose et al., 1995), and it can also improve heart function; and increase in left ventricular ejection fraction and exercise capacity in the cycling testImprove (Harmati et al., 1996).
SSRI treatment can also reduce the likelihood of thrombosis in patients with depression (Shapiro et al., 1997).
Other antidepressants are atypical antidepressants, Buppin and Mianserin, and Doxepin, which do not slow down heart disease and are therefore used for cardiovascular disease with depressive disorders.
Trazodone does not slow down the heart rate, but can cause orthostatic hypotension (Glassman and Preud, homme, 1993; Lane et al., 1994).
Other treatments for SSRIs and morphobexamide are first-line treatments for depressive disorders in hypertensive people.
However, when the case is toxic to the drug (that is, the lack of sufficient clinical effect for the correct treatment of two or more acute and multiple times) or the drug is intolerant, the addition of lithium carbonate and thyroid drugs or folic acid is also not effective.Medication may be appropriate (Bernstein, 1995; Goodwin and Jamison, 1990).
See details of non-drug treatment in Chapter 3.