Treatment-Resistant Depression and Mortality After Acute Coronary Syndrome

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American Journal of Psychiatry (Impact Factor: 12.3). 05/2009; 166(4):410-7. DOI: 10.1176/appi.ajp.2008.08081239
Source: PubMed


Depression is a risk factor for morbidity and mortality in patients with coronary heart disease, especially following acute coronary syndrome. Evidence from recent clinical trials suggests that treatment-resistant depression may be associated with a particularly high risk of mortality or cardiac morbidity in patients following acute coronary syndrome. This article reviews this evidence and considers possible explanations for this relationship. Directions for future research are also considered, with particular emphasis on efforts to elucidate the underlying mechanisms and to develop more efficacious treatments for depression in patients with coronary heart disease.

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Available from: Robert M Carney,
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    • "Although the high risk estimates may be inflated due to incomplete and biased reporting of adjustment, these meta-analytic data provide evidence for depression as a risk factor in the development and course of CVD. In addition, (Carney & Freedland, 2009) have reviewed the literature in order to identify subtypes of depression which are associated with the highest risk of cardiac events in coronary heart patients. They discuss existing evidence from several large clinical trials, such as ENRICHD, MIND-IT, and SADHART. "

    Psychiatric Disorders - New Frontiers in Affective Disorders, Edited by D. Schoepf, 05/2013: chapter 13;
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    • "to non-TRD patients ( Gibson et al. 2010 ) . Although TRD appears to be a common clinical condition , remarkably little is known about the underlying biology ( Carney and Freedland 2009 ) . Patients with TRD exhibit right superior, mediofrontal , and striatal atrophy , as well as hippocampal and rostral ante - rior cingulate cortex changes , compared to non - TRD and healthy controls ( Shah et al . "
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    ABSTRACT: RATIONALE: Although a number of studies investigated the link between major depressive disorder (MDD) and metabolic syndrome (MetS), the association between MetS and treatment-resistant depression (TRD) is still not clear. OBJECTIVES: The aim of the study was to investigate the relationship between TRD and MetS and/or components of MetS and cardiovascular risk factors. Given the high prevalence of both conditions, the hypothesis was that TRD would be significantly associated with MetS. METHODS: This cross-sectional study included 203 inpatients with MDD, assessed for the treatment resistance, MetS and its components, and severity of MDD. Diagnoses and evaluations were made with SCID based on DSM-IV, National Cholesterol Education Program Adult Treatment Panel III criteria, and the Hamilton Depression Rating Scale. RESULTS: TRD prior to study entry was found in 26.1 % of patients, while MetS was observed in 33.5 % of patients. The prevalence of MetS did not differ significantly between TRD and non-TRD patients. In addition, the frequency of the altered values of particular components of the MetS or cardiovascular risk factors was not associated with treatment resistance in depressed patients. Patients with TRD were older, had a higher number of lifetime episodes of depression and suicide attempts, and longer duration of MDD compared to non-TRD patients. CONCLUSIONS: The occurrence of either MetS or the particular components of the MetS and other cardiovascular risk factors was similar between TRD and non-TRD patients. Although there is a bidirectional relationship between depression and MetS, neither MetS nor its components appear to influence treatment resistance to antidepressants.
    Psychopharmacology 04/2013; 230(1). DOI:10.1007/s00213-013-3085-x · 3.88 Impact Factor
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    • "To determine the optimal treatment for perimenopausal depression, clinicians must weigh the risks of untreated depression and the benefits of treatment. Untreated depression during the perimenopause exacerbates heart disease, diabetes, and osteoporosis.23–26 More specifically, with regard to cardiovascular (CV) disease, a higher prevalence of depressive disorders was associated with more severe atherosclerosis;27 recurrent depressive, but not anxiety, disorders were associated with a two-fold increase in the risk of carotid atherosclerosis in middle-aged women, however, lifetime history of a single depressive episode was not associated with increased risk of plaque, suggesting that prevention of recurrent depressive episodes may prevent further progression of atherosclerosis; patients with depressive symptoms have lower health benefits (lower functioning) after coronary artery bypass surgery;28 symptoms of depression are significantly related to increased risk of CV events in women suspected of myocardial ischemia,29 to death from CV disease and, based on the findings from the WHI observational study, to all-cause mortality, even after controlling for established CV disease risk factors.30 "
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    ABSTRACT: Only recently has the perimenopause become recognized as a time when women are at risk for new onset and recurrence of major depression. Untreated depression at this time not only exacerbates the course of a depressive illness, but also puts women at increased risk for sleep disorders, cardiovascular disease, diabetes, and osteoporosis. Although antidepressant medication is the mainstay of treatment, adjunctive therapy, especially with estrogen replacement, may be indicated in refractory cases, and may speed the onset of antidepressant action. Many, but not all, studies, report that progesterone antagonizes the beneficial effects of estrogen. Although some antidepressants improve vasomotor symptoms, in general they are not as effective as estrogen alone for relieving these symptoms. Estrogen alone, however, does not generally result in remission of major depression in most (but not all) studies, but may provide benefit to some women with less severe symptoms if administered in therapeutic ranges. The selective serotonin reuptake inhibitors (SSRIs) in addition to estrogen are usually more beneficial in improving mood than SSRIs or estrogen treatment alone for major depression, whereas the selective norepinephrine and serotonin reuptake inhibitors do not require the addition of estrogen to exert their antidepressant effects in menopausal depression. In addition to attention to general health, hormonal status, and antidepressant treatment, the optimal management of perimenopausal depression also requires attention to the individual woman's psychosocial and spiritual well being.
    International Journal of Women's Health 08/2010; 2(1):143-51. DOI:10.2147/IJWH.S7155
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