2007 Heart-Brain summit proceedings

Impacts of depression and emotional distress on cardiac disease

Wei Jiang, MD

Associate Professor of Internal Medicine and of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC

Jiang001@mc.duke.edu

ABSTRACT

Depression is a primary risk factor for ischemic heart disease (IHD) and a secondary risk factor
for worsened prognosis in patients with IHD and heart failure. Mental stress‚ induced myocardial ischemia appears to be a significant mechanism by which depression increases the risk of death and morbidity in patients with IHD. A number of trials have evaluated the effect of therapy for depression in patients with cardiac disease, and more are ongoing. Selective serotonin reuptake inhibitors (SSRIs) are effective in improving depressive symptoms in cardiac patients and are relatively safe in these patients; tricyclic antidepressants are less safe in these patients. Early evidence suggests that antidepressant therapy with SSRIs may be associated with improved cardiac outcomes in depressed cardiac patients, but further study is needed.

CITATIONS

  1. Kessler RC, Berglund P, Demler O, et al.
    The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA 2003; 289:3095–3105.
    http://www.ncbi.nlm.nih.gov/pubmed/12813115
  2. Malzberg B.
    Mortality among patients with involutional melancholia. Am J Psychiatry 1937; 93:1231–1238.
    http://ajp.psychiatryonline.org/cgi/content/abstract/93/5/1231
  3. van Melle JP, de Jonge P, Spijkerman TA, et al.
    Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: a meta-analysis. Psychosom Med 2004; 66:814–822. http://www.ncbi.nlm.nih.gov/pubmed/15564344
  4. Barth J, Schumacher M, Herrmann-Lingen C.
    Depression as a risk factor for mortality in patients with coronary heart disease: a metaanalysis. Psychosom Med 2004; 66:802–813.
    http://www.ncbi.nlm.nih.gov/pubmed/15564343
  5. Jiang W, Alexander J, Christopher E, et al.
    Relationship of depression to increased risk of mortality and rehospitalization in patients with congestive heart failure. Arch Intern Med 2001; 161:1849–1856.
    http://www.ncbi.nlm.nih.gov/pubmed/11493126
  6. Rutledge T, Reis VA, Linke SE, Greenberg BH, Mills PJ.
    Depression in heart failure: a meta-analytic review of prevalence, intervention effects, and associations with clinical outcomes. J Am Coll Cardiol 2006; 48:1527–1537.
    http://www.ncbi.nlm.nih.gov/pubmed/17045884
  7. Rugulies R.
    Depression as a predictor for coronary heart disease: a review and meta-analysis. Am J Prev Med 2002; 23:51–61.
    http://www.ncbi.nlm.nih.gov/pubmed/12093424
  8. Deanfield JE, Shea M, Ribiero P, et al.
    Transient ST-segment depression as a marker of myocardial ischemia during daily life. Am J Cardiol 1984; 54:1195–1200.
    http://www.ncbi.nlm.nih.gov/pubmed/6334436
  9. Gullette ECD, Blumenthal JA, Babyak M, et al.
    Effects of mental stress on myocardial ischemia during daily life. JAMA 1997; 277:1521–1526.
    http://www.ncbi.nlm.nih.gov/pubmed/9153365
  10. Rozanski A, Bairey CN, Krantz DS, et al.
    Mental stress and the induction of myocardial ischemia in patients with ischemic heart disease. N Engl J Med 1988; 318:1005–1011.
    http://www.ncbi.nlm.nih.gov/pubmed/3352695
  11. Jiang W, Babyak M, Krantz DS, et al.
    Mental stress–induced myocardial ischemia and cardiac events. JAMA 1996; 275:1651–1656.
    http://www.ncbi.nlm.nih.gov/pubmed/8637138
  12. Blumenthal JA, Jiang W, Waugh RA, et al.
    Mental stress-induced ischemia in the laboratory and ambulatory ischemia during daily life. Association and hemodynamic features. Circulation 1995; 92:2102–2108.
    http://www.ncbi.nlm.nih.gov/pubmed/7554188
  13. Yeung AC, Vekshtein VI, Krantz DS, et al.
    The effect of atherosclerosis on the vasomotor response of coronary arteries to mental stress. N Engl J Med 1991; 325:1551–1556.
    http://www.ncbi.nlm.nih.gov/pubmed/1944439
  14. Dakak N, Quyyumi AA, Eisenhofer G, Goldstein DS, Cannon RO.
    Sympathetically mediated effects of mental stress on the cardiac microcirculation of patients with coronary artery disease Am J Cardiol 1995; 76:125–130.
    http://www.ncbi.nlm.nih.gov/pubmed/7611145
  15. Goldberg AD, Becker LC, Bonsall R, et al.
    Ischemic, hemodynamic, and neurohormonal responses to mental and exercise stress. Experience from the Psychophysiological Investigations of Myocardial Ischemia Study (PIMI). Circulation 1996; 94:2402–2409.
    http://www.ncbi.nlm.nih.gov/pubmed/8921780
  16. Sung BH, Wilson MF, Robinson C, et al.
    Mechanisms of myocardial ischemia induced by epinephrine: comparison with exerciseinduced ischemia. Psychosom Med 1988; 4:381–393.
    http://www.ncbi.nlm.nih.gov/pubmed/3413271
  17. Specchia G, Falcone C, Traversi E, et al.
    Mental stress as a provocative test in patients with various clinical syndromes of coronary heart disease. Circulation 1991; 83(Suppl 4):II108–II114.
    http://www.ncbi.nlm.nih.gov/pubmed/2009619
  18. Krantz DS, Santiago HT, Kop WJ, Bairey Merz CN, Rozanski A, Gottdiener JS.
    Prognostic value of mental stress testing in coronary artery disease. Am J Cardiol 1999; 84:1292–1297.
    http://www.ncbi.nlm.nih.gov/pubmed/10614793
  19. Sheps DS, McMahon RP, Becker L, et al.
    Mental stress-induced ischemia and all-cause mortality in patients with coronary artery eisease: results from the Psychopysiological Investigations of Myocardial Ischemia Study. Circulation 2002; 105:1780–1784.
    http://www.ncbi.nlm.nih.gov/pubmed/11956119
  20. Jiang W, Babyak MA, Rozanski A, et al.
    Depression and increased myocardial ischemic activity in patients with ischemic heart disease. Am Heart J 2003; 146:55–61.
    http://www.ncbi.nlm.nih.gov/pubmed/12851608
  21. Roose SP, Laghrissi-Thode F, Kennedy JS, et al.
    Comparison of paroxetine and nortriptyline in depressed patients with ischemic heart disease. JAMA 1998; 279:287–291.
    http://www.ncbi.nlm.nih.gov/pubmed/9450712
  22. Nelson JC, Kennedy JS, Pollock BG, et al.
    Treatment of major depression with nortriptyline and paroxetine in patients with ischemic heart disease. Am J Psychiatry 1999; 156:1024–1028.
    http://www.ncbi.nlm.nih.gov/pubmed/10401446
  23. Glassman AH, O’Connor CM, Califf RM, et al.
    Sertraline Antidepressant Heart Attack Randomized Trial (SADHART) Group. Sertraline treatment of major depression in patients with acute MI or unstable angina. JAMA 2002; 288:701–709.
    http://www.ncbi.nlm.nih.gov/pubmed/12169073
  24. Lespérance F, Frasure-Smith N, Koszycki D, et al.
    Effects of citalopram and interpersonal psychotherapy on depression in patients with coronary artery disease: the Candaian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy (CREATE) trial. JAMA 2007; 297:367–379.
    http://www.ncbi.nlm.nih.gov/pubmed/17244833
  25. van den Brink RH, Van Melle JP, Honig A, et al.
    Treatment of depression after myocardial infarction and the effects on cardiac prognosis and quality of life: rationale and outline of the Myocardial INfarction and Depression-Intervention Trial (MIND-IT). Am Heart J 2002; 144:219–225.
    http://www.ncbi.nlm.nih.gov/pubmed/12177637
  26. De Jonge P, Hong A, Schene AH, et al.
    Effects of antidepressive therapy for the treatment of depression following myocardial infarction: results from the Myocardial Infarction and Depression Intervention Trial (MIND-IT) [abstract]. Psychosom Med 2006; 68:A-7.
    (No web listing found.)
  27. Berkman LF, Blumenthal J, Burg M, et al; ENRICHD investigators.
    Effects of treating depression and low perceived social support on clinical events after myocardial infarction: the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Randomized Trial. JAMA 2003; 289:3106–3116.
    http://www.ncbi.nlm.nih.gov/pubmed/12813116
  28. Frasure-Smith N, Lespérance F, Prince RH, et al.
    Randomised trial of home-based psychosocial nursing intervention for patients recovering from myocardial infarction. Lancet 1997; 350:473–479.
    http://www.ncbi.nlm.nih.gov/pubmed/9274583
  29. Pollock BG, Laghrissi-Thode F, Wagner WR.
    Evaluation of platelet activation in depressed patients with ischemic heart disease after paroxetine or nortriptyline treatment. J Clin Psychopharmacol 2000; 20:137–140.
    http://www.ncbi.nlm.nih.gov/pubmed/10770450
  30. Musselman DL, Marzec UM, Manatunga A, et al.
    Platelet reactivity in depressed patients treated with paroxetine: preliminary findings. Arch Gen Psychiatry 2000; 57:875–882.
    http://www.ncbi.nlm.nih.gov/pubmed/10986551
  31. Serebruany VL, Glassman AH, Malinin AI, et al.
    Platelet/endothelial biomarkers in depressed patients treated with the selective serotonin reuptake inhibitor sertraline after acute coronary events: the Sertraline AntiDepressant Heart Attack Randomized Trial (SADHART) Platelet Substudy. Circulation 2003; 108:939–944.
    http://www.ncbi.nlm.nih.gov/pubmed/12912814
  32. Yeragani VK, Pesce V, Jayaraman A, et al.
    Major depression with ischemic heart disease: effects of paroxetine and nortriptyline on long-term heart rate variability measures. Biol Psychiatry 2002; 52:418–429.
    http://www.ncbi.nlm.nih.gov/pubmed/12242058
  33. Yeragani VK, Roose S, Mallavarapu M, et al.
    Major depression with ischemic heart disease: effects of paroxetine and nortriptyline on measures of nonlinearity and chaos of heart rate. Neuropsychobiology 2002; 46:125–135.
    http://www.ncbi.nlm.nih.gov/pubmed/12422059
  34. Rechlin T.
    The effects of psychopharmacological therapy on heart rate variation. Nervenarzt 1995; 66:678–685.
    http://www.ncbi.nlm.nih.gov/pubmed/7477605