2009 issue 1

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Volume 18, issue 1

Review

The influence of depression and antidepressive treatment on the development and course of ischemic heart disease

Grzegorz Nawarski1, Tomasz Pawełczyk2, Jolanta Rabe-Jabłońska2
1. Z Poradni Kardiologicznych SPZOZ w Poddębicach i Centrum Medycznego Bazarowa w Łodzi
2. Z Kliniki Zaburzeń Afektywnych i Psychotycznych Katedry Psychiatrii Uniwersytetu Medycznego w Łodzi
Postępy Psychiatrii i Neurologii 2009; 18 (1): 85-92
Keywords: depression, ischemic heart disease, antidepressive treatment

Abstract

Objectives. To review the research literature concerning: (1) the effect of depression on the development and course of ischemic heart disease (IHD), (2) probablepathophysiological mechanisms underlying the association between IHD and depression, and (3) most recent studies on the impact of antidepressants on the course of IHD and comorbid depression (including SADHART, CREATE, ENRICHD, CAST, CASH, MIND-IT).
Review. The hitherto conducted retrospective andprospective clinical studies, as well as meta-analyses clearly indicate a high correla-tion between thepresence of depression and the risk for developing IHD in currently healthy persons, and between the incidence and severity of depressive symptoms on one hand and coronary symptoms severity in persons diagnosed with IHD, on the other hand. Among numerous data suggesting probable mechanisms of the association between depression and IHD, the following seem to be most important: hyper-reactivity of the hypothalamic-pituitary-adrenal (HPA) axis with the associated catecholaminergic system activation, platelet dysfunction with the coagulation system activation, the immune system pathological hyperactivity of an inflammatory character, vascular endothelium dysfunction, and increased homocysteine concentrations. The most recent evaluative studies show that appropriate pharmacotherapy and psychotherapy of depression significantly improve the course and prognosis of IHD, among others, by reducing the risk of heart stroke and death. The SSRI medications turned out to be the safest.
Conclusions. (1) Depression increases the risk for IHD development, is freąuently comorbid with IHD, and has a significant effect on its course and prognosis - thus, there is a need for early diagnosis and effective treatment of depression. (2) Appropriate pharmacological treatment and psychotherapy may improve the course of IHD and its prognosis.

Address for correspondence:
Prof. Jolanta Rabe-Jabłońska
Klinika Zaburzeń Afektywnych i Psychotycznych Katedry Psychiatrii Uniwersytetu Medycznego w Łodzi
ul. Czechosłowacka 8/10, 92-216 Łódź