DEPRESSION AND CORONARY ARTERY DISEASE

Depression And Coronary Artery Disease

Depression And Coronary Artery Disease

Introduction

Everyone experiences feelings of unhappiness and sadness occasionally, but when these depressed feelings start to dominate everyday life and cause physical and mental deterioration, they become what are known as depressive disorders. Each year in the United States, depressive disorders affect an estimated 17 million people at an approximate annual direct and indirect cost of $53 billion. One in four women is likely to experience an episode of severe depression in her lifetime, with 10 to 20 percent lifetime prevalence, compared to 5 to 10 percent for men.

It has been observed that for many years, pharmacologic treatment for patients with depression and stable CAD was based on tricyclic antidepressive agents (TCA), such as amitriptyline,imipramine, nortriptyline, desipramine, and doxepin. TCA's have several adverse effects that complicate their use in patients with cardiac disease. Tricyclic antidepressive agents cause orthostatic hypotension, which may result in haemodynamic instability, especially in patients with conduction system disease and congestive heart failure. Furthermore, TCA's have anticholinergic effects and a high potential for drug interaction. TCA's also have significant anti-arrhythmic activity and can be classified as type IA anti-arrhythmic agents, but also show arrhythmogenic potential.

In contrast, in my view, the selective serotonine reuptake inhibitors (SSRI) have only minimal cardiac side effects: the only effect of citalopram on ECG findings was a small reduction in heart rate (less or equal to 8beats per minute). There were no significant effects on PQ, QRS, or QTc intervals, indicating that citalopram has no effect on cardiac conduction and repolarization during short- or long-term treatment.

Psychiatric and physical illnesses frequently coexist. Depression is associated clinically with heart disease in several ways including the risk of arrhythmia, alteration in the amount of blood flowing to the coronary arteries, increased risk of blood clots and increased cardiac arrest.

Coronary artery disease has emerged as the leading cause of death and disability in the United States. According to the World Health Organization by the year 2020 both coronary artery disease and depression will be the two major causes of disability (Depressive). This paper will look at the relationship between depression and coronary artery disease.

Recently new risk factors for coronary artery disease (CAD) have been identified, among them emotional distress and depression. Taking into account that lifetime prevalence of depression is as high as 17%, it is not surprising that CAD and depression are often comorbid conditions. Both of them cause a significant decrease in quality of life for the patient and impose a significant economic burden on society. The association of depression and CAD has been noted already many years ago. (Imran 2009)

Research over the past decade on the link between depression and coronary artery disease (CAD) has moved from establishing the epidemiologic association between depression and CAD to a focus on whether and how treating depression in patients with CAD benefits these patients. Evidence to date indicates that depression therapy does improve depression, albeit somewhat modestly, in CAD ...