The authors evaluated the impact of an increase in depressive symptoms at 6 months after elective coronary artery bypass graft surgery on long-term cardiac morbidity and mortality between 6 and 36 months postoperatively. Patients who had low scores for depressive symptomatology pre-operatively and who completed follow-up at 6 months were contacted again 36 months after surgery to assess cardiac and neurologic morbidity and mortality. At 36 months after surgery, an interval history was completed, and baseline questionnaires were readministered. Follow-up was obtained on 123/124 patients (99%). The rate of combined new cardiac morbidity/mortality between 6 and 36 months was 13.6% among those with newly increased depressive symptoms at 6 months vs. 3.0% in the patients without new depressive symptoms at 6 months. Only an increase in depressive symptoms at 6 months was related to the occurrence of subsequent cardiac complications between 6 and 36 months. In this small sample of patients, increased depressive symptoms at 6 months after surgery appear to be associated with the occurrence of subsequent major cardiac morbidity/ mortality.
"Depression or depressive symptoms are a prevalent and debilitating form of maladaptive neuroplasticity affecting approximately 20–40% of people with CHD [88–90]. Depression and cardiovascular events have been widely studied in CHD; depressed people are more likely to develop CHD (meta-analytic effect size, 1.5–2.7) "
[Show abstract][Hide abstract] ABSTRACT: Physical activity is a seemingly simple and clinically potent method to decrease morbidity and mortality in people with coronary heart disease (CHD). Nonetheless, long-term maintenance of physical activity remains a frustratingly elusive goal for patients and practitioners alike. In this paper, we posit that among older adults with CHD, recidivism after the initiation of physical activity reflects maladaptive neuroplasticity of malleable neural networks, and people will revert back to learned and habitual physical inactivity patterns, particularly in the setting of stress or depression. We hypothesize that behavioral interventions that successfully promote physical activity may also enhance adaptive neuroplasticity and play a key role in the maintenance of physical activity through the development of new neuronal pathways that enhance functional ability in older adults. Conversely, without such adaptive neuroplastic changes, ingrained maladaptive neuroplasticity will prevail and long-term maintenance of physical activity will fail. In this paper we will: (1) describe the enormous potential for neuroplasticity in older adults; (2) review stress and depression as examples of maladaptive neuroplasticity; (3) describe an example of adaptive neuroplasticity achieved with a behavioral intervention that induced positive affect in people with CHD; and (4) discuss implications for future work in bench to bedside translational research.
"McKhann et al. showed between 13% and 9% of 124 CABG patients at one month and twelve month follow up, respectively, reported clinically relevant depressive symptoms not evident at the time of surgery. Peterson et al. explain newly developed depressive symptoms resulting from the stressors of surgery that can produce an adjustment response, or reactive type depression. In any case, as described below, identifying depression in the CABG surgery patient is complicated by the somatic symptoms experienced in CAD and the physical stressors of surgery. "
[Show abstract][Hide abstract] ABSTRACT: Research to date indicates that the number of coronary artery bypass graft (CABG) surgery patients affected by depression (i.e., major, minor, dysthymia) approximates between 30% and 40% of all cases. A longstanding empirical interest on psychosocial factors in CABG surgery patients highlights an association with increased risk of morbidity in the short and longer term. Recent evidence suggests that both depression and anxiety increase the risk for mortality and morbidity after CABG surgery independent of medical factors, although the behavioral and biological mechanisms are poorly understood. Though neither depression nor anxiety seem to markedly affect neuropsychological dysfunction, depression confers a risk for incident delirium. Following a comprehensive overview of recent literature, practical advice is described for clinicians taking into consideration possible screening aids to improve recognition of anxiety and depression among CABG surgery patients. An overview of contemporary interventions and randomized, controlled trials are described, along with suggestions for future CABG surgery research.
"It is well established that depression adversely affects outcomes from chronic medical conditions. Patients with coronary artery disease and comorbid depression have functional disability , poorer outcomes following coronary artery bypass surgery , a worse prognosis following an episode of unstable angina  and increased mortality  as compared to those without depression. The biologic rationale for increased vulnerability of depressed patients with coronary artery disease is thought to be a manifestation of hypothalalmic–pituitary–adrenocortical axis hyperactivity, decreased heart rate variability and changes in platelet receptor function . "
[Show abstract][Hide abstract] ABSTRACT: Depression is common in older adults and often coexists with multiple chronic diseases, which may complicate its diagnosis and treatment.
To determine whether or not the presence of multiple comorbid medical illnesses affects patient response to a multidisciplinary depression treatment program.
Preplanned analyses of Improving Mood-Promoting Access to Collaborative Treatment (IMPACT), a randomized controlled trial of 1801 depressed older adults (> or =60 years), which was performed at 18 primary care clinics from eight health care organizations in five states across the United States from July 1999 to August 2001.
Intervention patients had access for up to 12 months to a depression care manager, supervised by a psychiatrist and a primary care expert, who offered education, care management and support of antidepressant management by the patient's primary care physician, or provided brief psychotherapy (Problem-Solving Treatment in Primary Care).
Depression, quality of life (QOL; scale of 0-10) and mental health component score (MCS) of the Short-Form 12 assessed at baseline, 3, 6 and 12 months.
Patients suffered from an average of 3.8 chronic medical conditions. Although patients with more chronic medical conditions had higher depression severity at baseline, the number of chronic diseases did not affect the likelihood of response to the IMPACT intervention when compared to care as usual. Intervention patients experienced significantly lower depression during all follow-up time points as compared with patients in usual care independent of other comorbid illnesses (P<.001). Intervention patients were also more likely to experience substantial response (at least a 50% reduction in depressive symptoms) regardless of the number of comorbidities, to experience improved MCS-12 scores at 3 and 12 months, and to experience improved QOL.
The presence of multiple comorbid medical illnesses did not affect patient response to a multidisciplinary depression treatment program. The IMPACT collaborative care model was equally effective for depressed older adults with or without comorbid medical illnesses.
General Hospital Psychiatry 01/2005; 27(1):4-12. DOI:10.1016/j.genhosppsych.2004.09.004 · 2.61 Impact Factor
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