Article

Treatment-Resistant Depression and Mortality After Acute Coronary Syndrome

Behavioral Medicine Center, 4320 Forest Park Blvd. Suite 301, St. Louis, MO 63108, USA.
American Journal of Psychiatry (Impact Factor: 12.3). 05/2009; 166(4):410-7. DOI: 10.1176/appi.ajp.2008.08081239
Source: PubMed

ABSTRACT

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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    • "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. "

    Full-text · Chapter · May 2013
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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.
    Full-text · Article · Apr 2013 · Psychopharmacology
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    • "The pathways that could explain the association with an increased risk of morbidity and mortality in subjects with a 'high-risk' psychiatric profile [2] are unknown. Depressive symptoms are considered to be a negative prognostic factor in patients with cardiovascular diseases [6] [7]. However, few data are available about the specific pathways implicated in the relationship between psychiatric symptoms and HT outcome. "
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    ABSTRACT: There is growing evidence of the importance of psychiatric risk factors for predicting the outcome of heart transplantation (HT) recipients. The aim of our study was to investigate the role of major depression and posttraumatic stress disorder (PTSD) in the prediction of the outcome of HT in a consecutive sample of 107 recipients. All subjects of the study underwent a structured diagnostic interview for assessing the presence of pretransplant and posttransplant major depression and transplantation-related PTSD 1 to 5 years after HT. The adherence to medical treatment was assessed some months after the structured interview. The medical outcome (acute rejections, cancer, mortality) was followed up for 8 years on average after the interview, using a prospective design. Estimated frequency of psychiatric diagnoses after HT was 12% for transplantation-related PTSD and 41% for major depression. The presence of an episode of major depression prior to HT is a significant independent risk factor for posttransplant malignancies. Age, posttransplant malignancies and poor adherence are significant predictors of mortality in the survival analyses. The present study highlights the importance of the assessment of psychosocial variables and psychiatric diagnoses before and after transplantation in HT recipients. Our findings have important clinical implications and require replication with larger samples.
    Full-text · Article · Jan 2011 · General hospital psychiatry
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