Article

Sertraline Treatment of Major Depression in Patients With Acute MI or Unstable Angina

August 2002
JAMA The Journal of the American Medical Association 288(6):701-9

August 2002
288(6):701-9

DOI:10.1016/S1062-1458(02)00908-X

Source
PubMed

Authors:

Karl Swedberg

University of Gothenburg

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Major depressive disorder (MDD) occurs in 15% to 23% of patients with acute coronary syndromes and constitutes an independent risk factor for morbidity and mortality. However, no published evidence exists that antidepressant drugs are safe or efficacious in patients with unstable ischemic heart disease. To evaluate the safety and efficacy of sertraline treatment of MDD in patients hospitalized for acute myocardial infarction (MI) or unstable angina and free of other life-threatening medical conditions. Randomized, double-blind, placebo-controlled trial conducted in 40 outpatient cardiology centers and psychiatry clinics in the United States, Europe, Canada, and Australia. Enrollment began in April 1997 and follow-up ended in April 2001. A total of 369 patients with MDD (64% male; mean age, 57.1 years; mean 17-item Hamilton Depression [HAM-D] score, 19.6; MI, 74%; unstable angina, 26%). After a 2-week single-blind placebo run-in, patients were randomly assigned to receive sertraline in flexible dosages of 50 to 200 mg/d (n = 186) or placebo (n = 183) for 24 weeks. The primary (safety) outcome measure was change from baseline in left ventricular ejection fraction (LVEF); secondary measures included surrogate cardiac measures and cardiovascular adverse events, as well as scores on the HAM-D scale and Clinical Global Impression Improvement scale (CGI-I) in the total randomized sample, in a group with any prior history of MDD, and in a more severe MDD subgroup defined a priori by a HAM-D score of at least 18 and history of 2 or more prior episodes of MDD. Sertraline had no significant effect on mean (SD) LVEF (sertraline: baseline, 54% [10%]; week 16, 54% [11%]; placebo: baseline, 52% [13%]; week 16, 53% [13%]), treatment-emergent increase in ventricular premature complex (VPC) runs (sertraline: 13.1%; placebo: 12.9%), QTc interval greater than 450 milliseconds at end point (sertraline: 12%; placebo: 13%), or other cardiac measures. All comparisons were statistically nonsignificant (P> or = .05). The incidence of severe cardiovascular adverse events was 14.5% with sertraline and 22.4% with placebo. In the total randomized sample, the CGI-I (P =.049), but not the HAM-D (P =.14), favored sertraline. The CGI-I responder rates for sertraline were significantly higher than for placebo in the total sample (67% vs 53%; P =.01), in the group with at least 1 prior episode of depression (72% vs 51%; P =.003), and in the more severe MDD group (78% vs 45%; P =.001). In the latter 2 groups, both CGI-I and HAM-D measures were significantly better in those assigned to sertraline. Our results suggest that sertraline is a safe and effective treatment for recurrent depression in patients with recent MI or unstable angina and without other life-threatening medical conditions.

Tratamiento de la depresión comórbida después de un síndrome coronario agudo: metaanálisis de ensayos controlados aleatorizados

Article

Apr 2024
BEHAV PSYCHOL

La depresión postsíndrome coronario agudo (post-SCA) aumenta el riesgo cardíaco; sin embargo, la eficacia de las terapias antidepresivas para su tratamiento no está suficientemente demostrada. Nuestro objetivo es metaanalizar ensayos controlados con muestras homogéneas que permitan explicar la inconsistencia de los resultados obtenidos hasta el momento. Tras revisar 1525 artículos, dos revisores independientes identificaron 7 estudios que cumplían criterios muy restrictivos para asegurar la homogeneidad de las muestras. Los resultados indicaron que los pacientes tratados con intervenciones de eficacia demostrada para la depresión reducen sus niveles de trastorno depresivo significativamente más que los sujetos sin este tratamiento, y que existen diferencias significativas en el número de pacientes que reducen los síntomas depresivos de forma clínicamente relevante. Además, se observaron menos eventos cardiovasculares adversos durante el tratamiento, aunque esta diferencia fue mínimamente significativa y no se mantuvo tras el seguimiento. Estos resultados sugieren que la inconsistencia de los datos actualmente disponibles podría deberse a dificultades metodológicas que evidencian la necesidad de nuevas investigaciones que aclaren el efecto del tratamiento de la depresión sobre el pronóstico post-SCA.

Treatment of comorbid depression after acute coronary syndrome: Meta-analysis of randomized controlled trials

Article

Apr 2024
BEHAV PSYCHOL

Depression post-acute coronary syndrome (ACS) increases cardiac risk; however, the efficacy of antidepressant therapies for its treatment has not been sufficiently demonstrated. Our aim is to meta-analyze controlled trials with homogeneous samples that allow us to explain the inconsistency of the results obtained so far. After reviewing 1525 articles, two independent reviewers identified 7 studies that met very restrictive criteria to ensure homogeneity of the samples. The results indicated that patients treated with interventions of proven efficacy for the depression, reduce their levels of depressive disorder significantly more than subjects without this treatment and that there are significant differences in the number of patients who reduce depressive symptoms in a clinically relevant way. In addition, fewer adverse cardiovascular events were observed during treatment, although this difference was minimally significant and was not maintained after the follow-up. These results suggest that the inconsistency of the currently available data could be due to methodological difficulties evidencing the need for further research to clarify the effect of depression treatment on post-ACS prognosis.

World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders – Version 3. Part I: Anxiety disorders

Article

Jul 2022

Aim: This is the third version of the guideline of the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Posttraumatic Stress Disorders (published in 2002, revised in 2008). Method: A consensus panel of 33 international experts representing 22 countries developed recommendations based on efficacy and acceptability of available treatments. In total, 1007 RCTs for the treatment of these disorders in adults, adolescents, and children with medications, psychotherapy and other non-pharmacological interventions were evaluated, applying the same rigorous methods that are standard for the assessment of medications. Result: This paper, Part I, contains recommendations for the treatment of panic disorder/agoraphobia (PDA), generalised anxiety disorder (GAD), social anxiety disorder (SAD), specific phobias, mixed anxiety disorders in children and adolescents, separation anxiety and selective mutism. Selective serotonin reuptake inhibitors (SSRI) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are first-line medications. Cognitive behavioural therapy (CBT) is the first-line psychotherapy for anxiety disorders. The expert panel also made recommendations for patients not responding to standard treatments and recommendations against interventions with insufficient evidence. Conclusion: It is the goal of this initiative to provide treatment guidance for these disorders that has validity throughout the world.

Psychiatric and Psychological Interventions for Depression in Patients With Heart Disease: A Scoping Review

Article

Full-text available

Nov 2020

Depression in patients with cardiovascular disease is independently associated with progression of heart disease, major adverse cardiac events, and mortality. A wide variety of depression treatment strategies have been studied in randomized controlled trials as the field works to identify optimal depression treatments in this population. A contemporary scoping review of the literature can help to consolidate and synthesize the growing and disparate literature on depression treatment trials in people with cardiovascular disease. We conducted a scoping review utilizing a systematic search of the literature via 4 databases (PubMed, PsycINFO, EMBASE, and Google Scholar) from database inception to March 2020. We identified 42 relevant randomized controlled trials of depression treatment interventions in patients with cardiac disease (n=9181 patients with coronary artery disease, n=1981 patients with heart failure). Selective serotonin reuptake inhibitors appear to be safe in patients with cardiac disease and to have beneficial effects on depression (and some suggestion of cardiac benefit) in patients with coronary artery disease, with less evidence of their efficacy in heart failure. In contrast, psychotherapy appears to be effective for depression in coronary artery disease and heart failure, but with less evidence of cardiac benefit. Newer multimodal depression care management approaches that utilize flexible approaches to patients' care have been less studied but appear promising across cardiac patient groups. Selective serotonin reuptake inhibitors may be preferred in the treatment of patients with coronary artery disease, psychotherapy may be preferred in heart failure, and more flexible depression care management approaches have shown promise by potentially using both approaches based on patient needs.

Antidepressant treatment in patients following acute coronary syndromes: a systematic review and Bayesian meta-analysis

Article

Full-text available

Sep 2020

Aims: The aim of this study is to investigate the effect of antidepressant therapy on mortality and cardiovascular outcomes in patients with acute coronary syndrome (ACS). Methods and results: We systematically searched PubMed, Embase, and the Cochrane Central Register of Controlled Trials and performed a Bayesian random-effects meta-analysis of randomized controlled trials that investigated antidepressant pharmacotherapy in patients following ACS. The primary outcome was all-cause mortality. Secondary outcomes were repeat hospitalizations and recurrent myocardial infarctions (MIs). Ten randomized controlled trials with a total of 1935 patients qualified for inclusion. Selective serotonin reuptake inhibitors were investigated in six, bupropion in three, and mirtazapine in one trial. Placebo was used as control in eight trials. There was no difference in all-cause mortality [odds ratio (OR) 0.97, 95% credible interval (CrI) 0.66-1.42] and recurrent MI (OR 0.64, 95% CrI 0.40-1.02) between patients receiving antidepressants compared with controls, whereas antidepressant therapy was associated with less repeat hospitalizations (OR 0.62, 95% CrI 0.40-0.94). In patients with ACS and concomitant depression, antidepressants reduced the odds of recurrent MI compared with usual care/placebo (OR 0.45, 95% CrI 0.25-0.81). Extended funnel plots suggest robustness of the observations. Conclusions: Antidepressants in patients following ACS have no effect on mortality but reduce repeat hospitalizations; in patients with depression, there is a reduced risk of recurrent MI with antidepressant therapy.

Behavioral Medicine for Patients with Heart Disease—The Case of Depression and Cardiac Rehabilitation

Article

Full-text available

Dec 2010

Intervention research on therapies that aim to treat depression and cardiovascular disease

Chapter

Full-text available

Jan 2020

Large, prospective, epidemiological studies of initially healthy individuals provide clear evidence that a history of major depressive disorder (MDD) increases risk of incident heart disease, with meta-analyses showing depression to carry a relative risk of 1.64 for cardiac incidence (Rugulies, 2002). Approximately 15–20% of patients with heart disease—e.g., stable coronary artery disease (CAD), unstable angina, or acute coronary syndrome (ACS)event—meet criteria for major depression (Carney and Freedland, 2008),while approximately 40% evidence clinically meaningful levels of depres-sive symptoms (Celano and Huffman, 2011), each of which increases risk for cardiac recurrence and mortality (Nicholson et al., 2006). Among ACS patients with depression during hospital admission, more than half have depressive symptoms prior to their cardiac event. In addition to the increased risk for cardiac recurrence and early mortality, depression in these patients is associated with increased rates of disability, and health-care expenditures (Lichtman et al., 2008). Given the adverse impact of comorbid depression on clinical outcomes and quality of life in patients with heart disease, a large clinical trial effort has been mounted over the past 3 decades to determine whether treating depression in these patients improves psychosocial and medical outcomes. These depression clinical trials have particularly been focused on immediate and recent post-ACS patients, and more recently, heart failure (HF) patients. This effort has specifically examined the effectiveness of cognitive-behavioral, pharmacological, and non-traditional interventions. The selection of interventions for these trials has been guided by the depression treatment evidence base (Archer et al., 2012; Donker et al., 2009; Hare et al., 2014; Linde et al., 2015). The aims of these trials have included both the mitigation of depression symptoms and improvement in medical outcomes. While some trials have shown improvements in depressive symptoms or quality of life, the effect of improved depression on cardiovascular disease (CVD) related outcomes has been disappointing at best. Furthermore, questions concerning the cost-effectiveness, feasibility, and resource implications of depression treatment in these patients remain to be addressed. In this chapter we provide a focused review of the intervention literature concerning depression in patients with CVD. We first review the literature on psychosocial/behavioral and related interventions, followed by reviews of pharmacotherapy interventions, and then a review of combined psychosocial/pharmacologic interventions.

DEPRESSION, ANXIETY AND MYOCARDIAL INFARCTION: EVERYTHING JUST BEGINS. PART II

Article

Jan 2007

Acute coronary syndrome-associated depression: Getting to the heart of the data

Article

Full-text available

May 2020
J AFFECT DISORDERS

Objectives: We sought to identify and consider methodological issues that may have limited or confounded investigations into links between depression and acute coronary syndrome (ACS) events. Methods: We reviewed salient research studies to identify such issues. Results: Against previous conclusions, we found that lifetime depression is unlikely to have any primary ACS impact, while we clarify that ‘incident depression’ (depression commencing at variable periods around the time of the ACS event) appears to confer a greater risk than non-incident depression. As the time periods of incident depressions are likely to have quite differing causes, evaluating any consolidated risk period appears unwise. It remains unclear whether it is ‘depression’ that provides the risk for ACS events or a higher order factor. Variable use of depression measures and failure to evaluate depressive sub-types have further limited clarification. The response by ACS patients to antidepressant medication appears limited, and it remains to be determined whether exposure to an antidepressant might be a contributing factor. Finally, studies may have focused on an excessively refined association, and neglected to recognise that depression is associated with a wide range of vascular events, suggesting that a broader conceptual model may be required. Limitations: The authors have considered only a limited set of studies in preparing this review, with the critique relying at times on subjective interpretation. Conclusions: After decades of research pursuing links between depression and ACS events explanatory links remain obscure, presumably reflecting a range of methodological issues that we have discussed in this paper.

A Thorough QT Study to Evaluate the Effects of a Supratherapeutic Dose of Sertraline on Cardiac Repolarization in Healthy Subjects

Article

Full-text available

Nov 2019

The effect of steady‐state supratherapeutic sertraline (Zoloft) on QT interval was assessed in a single‐center, randomized, 3‐way crossover, double‐blind, placebo‐ and moxifloxacin‐controlled thorough QT study. Healthy adults received sertraline 400 mg/day, moxifloxacin 400 mg, and placebo, with a washout period (≥14 days) between treatments. A 12‐lead electrocardiogram was recorded in triplicate before dosing and at selected time points up to 72 hours after dosing. Analysis of covariance using a mixed‐effect model with sequence, period, treatment, time, and treatment‐by‐time interaction as fixed effects; subject within sequence as a random effect; and baseline QT corrected for heart rate using Fridericia formula (QTcF) as a covariate was conducted. A 90% confidence interval for the least squares (LS) mean difference in QTcF between active treatment and placebo was computed for each postdose time point. Exposure‐response was assessed using linear mixed‐effect modeling. Fifty‐four subjects were enrolled. Over 24 hours after dosing, the LS mean difference in QTcF for sertraline versus placebo ranged from 5.597 milliseconds to 9.651 milliseconds. The upper bound of the 90% confidence interval for the LS mean difference exceeded a predefined 10‐millisecond significance threshold at the 4‐hour postdose time point only (LS mean, 9.651 milliseconds [90% confidence interval, 7.635‐11.666]). In the exposure‐response analysis, QTcF values increased significantly with increasing sertraline concentration (slope = 0.036 milliseconds/ng/mL; P < .0001). Predicted change from baseline in QTcF at therapeutic maximum plasma sertraline concentration was 3.57 milliseconds. This thorough QTc study demonstrated a positive signal for QTc prolongation for sertraline at the steady‐state 400‐mg/day dose.

Intervention options: depression and cardiovascular disease during COVID-19

Article

Full-text available

Nov 2023

An attempt to review links of cardiovascular disease (CVD) and depression and present appropriate treatment methods for handling depression in the COVID-19 pandemic is made. Although depression constitutes one of the major mental health challenges that humankind must encounter in the 21st century it remains undiagnosed and untreated in CVD patients. Its great influence on the progress of CVD led to its classification as a risk factor along with dyslipidemia, arterial hypertension, diabetes, obesity, substance use, sedentary lifestyle (poor diet, stress) making imperative the need for treatment methods. As during COVID-19 pandemic we witnessed the elevation of mental distress as involving both lifestyle choices and dealing with unprecedented life situations while inducing psychological distress or exacerbating preexisting physical and mental health problems – depression could act both as a contributor to and as the result of CVD. A 4-step intervention program is suggested.

Intervention options: depression and cardiovascular disease during COVID-19

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Nov 2023

Intervention options: depression and cardiovascular disease during COVID-19

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Nov 2023

Frequency of Depression and Anxiety in Patients with Acute Coronary Syndrome

Article

Full-text available

Apr 2023

Objectives: The objective of the current study was to determine the frequency of anxiety and depression among patients diagnosed with acute coronary syndrome (ACS) at a tertiary care cardiac center in Pakistan. Methodology: This cross-sectional study was conducted at a tertiary care cardiac center in Pakistan from May to November 2019. We included patients of either gender, between 30 and 70 years of age, diagnosed with ACS, and presented within 72 hours of onset of symptoms. After the standard treatment of the condition, the Beck Depression Inventory Scale (BDI) and Beck Anxiety Inventory (BAI) were used to assess post-AMI depression and anxiety. The BDI ≥17 was categorized as depression and BAI ≥11 was taken as anxiety. Results: In the selected sample of 122 patients, the mean age was 58.7 ± 10.2 years and 88 (72.1%) patients were male. Diabetes mellitus was detected in 76 (62.3%) patients and 64 (52.5%) patients were smokers. The mean BDI score was 28.6 ± 6.5 and mean BAI score was 19.5 ± 5.1. Anxiety and depression were observed in 36 (29.5%) and 51 (41.8%) patients, respectively. Conclusion: Depression and anxiety are a common remnants of ACS, hence, in our day to day clinical practice, appropriate consideration should be given to the psychological wellbeing of patients in addition to the management of ACS.

Associations between cardiovascular diseases and psychosocial factors and options for intervention

Article

Full-text available

Mar 2023
Orv Hetil

Coronary artery disease is a highly prevalent heart disease and the leading cause of morbidity and mortality in developed countries. During the last decades, numerous studies have focused on the comprehension of the relationship between coronary heart disease and different psychosocial factors. Coronary artery bypass graft surgery is a common treatment for coronary artery disease and is usually associated with improved clinical outcomes. Symptoms of anxiety and unipolar depression are common psychological disorders in patients awaiting coronary artery bypass graft surgery. Several prospective cohort studies have been carried out on the factors affecting the short- and long-term outcome of coronary artery bypass graft surgery. Scientific literature reports that not only clinical features, e.g., cardial state, comorbidity or intraoperative factors influence the outcome of cardiac surgery. In a comprehension of psychosocial factors over traditional risk factors (hypertension, LDL cholesterol level, diabetes mellitus, smoking, obesity and physical inactivity) on morbidity and mortality rates, the previously mentioned ones proved to be determinant. Gathering patients' psychological status before undergoing heart surgery and providing psychological interventions if they are indicated would be beneficial. A better understanding of whether and when psychological interventions affect specific outcomes may help design even more powerful interventions and make better predictions of which patients will benefit from which psychological intervention. Psychological assessment and intervention thus merit integration into routine surgical care. Orv Hetil. 2023; 164(11): 411-419.

General practice management of depression among patients with coronary heart disease in Australia

Article

Full-text available

Dec 2022

Background Incident depression is associated with coronary heart disease (CHD) and increased morbidity and mortality. Treatment of depression with antidepressants and psychotherapy can be beneficial for these patients to reduce the risk of further CHD events. Ongoing management of CHD and depression mainly occurs in the community, but little is known about the identification and care of patients with comorbid CHD and depression in general practice. This study explores the prescription of antidepressants for these patients by sociodemographic variables. Methods This is an open cohort study with de-identified data based on electronic medical records of 880,900 regular patients aged 40 + years from a national general practice database in Australia (MedicineInsight). Data from 2011–2018 was used to classify patients as newly recorded CHD (CHD recorded in 2018 but not in previous years), previously recorded CHD (CHD recorded between 2011–2017) or no recorded history of CHD. Antidepressant prescribing in 2018 considered active ingredients and commercial brand names. The association between sociodemographic variables and antidepressant prescribing was tabulated according to the CHD status. Results The proportion of current depression among patients with newly recorded CHD was 11.4% (95%CI 10.3–12.6), 10.5% among those with previously recorded CHD (95%CI 10.0–11.1) and 9.6% among those with no recorded history of CHD (95%CI 9.2–10.1). Antidepressant prescribing was slightly higher among those with newly recorded CHD (76.4%; 95%CI 72.1–80.6) than among those with previously recorded CHD (71.6%; 95%CI 69.9–73.2) or no history of CHD (69.5%; 95%CI 68.6–70.4). Among males with newly recorded CHD and depression, antidepressant prescribing was more frequent in major cities or inner regional areas (~ 81%) than in outer/remote Australia (66.6%; 95% CI 52.8–80.4%). Conclusions Although antidepressant prescribing was slightly greater in those with newly recorded CHD compared to those with depression alone, its clinical significance is uncertain. Much larger differences in prescribing were seen by geographic location and could be addressed by innovations in clinical practice.

Management of Psychiatric Disorders in Patients with Cardiovascular Diseases

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Full-text available

Mar 2022

Qi-Regulating and Blood Circulation-Promoting Therapy Improves Health Status of Stable Angina Pectoris Patients with Depressive Symptoms

Article

Full-text available

Sep 2021
EVID-BASED COMPL ALT

Depressive symptoms have been found to be highly prevalent among patients with coronary heart disease (CHD) and seriously affect the patients’ quality of life. However, most psychotropic drugs have warnings about potential side effects. Accordingly, safer effective alternatives are urgently demanded. Angina pectoris of CHD is considered as “chest stuffiness and heartache syndrome” in traditional Chinese medicine, with the major syndrome type named Qi stagnation and blood stasis. Qi-regulating and blood circulation-promoting therapy has increasingly shown unique advantages in CHD patients. This study investigated the efficacy of Xuefu Zhuyu decoction, a representative prescription of Qi-regulating and blood circulation-promoting therapy, on angina pectoris patients with depressive symptoms. Depressive symptoms were stratified at baseline in 30 patients with stable angina pectoris who participated in both baseline and 12-week follow-up studies. After performing a stratified analysis, the angina pectoris-specific health status and traditional Chinese medicine “chest stuffiness and heartache syndrome” were evaluated by self-reports using the associated questionnaire scales, respectively. We measured serum concentrations of serotonin, brain-derived neurotrophic factor, and ATP, which are associated with the development of depression. We found that the Xuefu Zhuyu granule significantly improved the angina pectoris-specific health status in patients after 12 weeks of treatment; specifically, it had a better curative effect on patients with depressive symptoms. Xuefu Zhuyu granule also significantly improved the chest stuffiness and heartache syndrome in patients with depressive symptoms (efficacy index is 61.24%, P

Mortality after electroconvulsive therapy

Article

Jun 2021

Background There are limited studies examining mortality associated with electroconvulsive therapy (ECT), and many studies do not include a control group or method to identify all patient deaths. Aims We aimed to evaluate the risk of death associated with ECT treatments over 30 days and 1 year. Method We conducted a study analysing electronic medical record data from the Department of Veterans Affairs healthcare system between 2000 and 2017. We compared mortality among patients who received ECT with a matched group of patients created through propensity score matching. Results Our sample included 123 479 individual ECT treatments provided to 8720 patients (including 5157 initial index courses of ECT). Mortality associated with individual ECT treatments was 3.08 per 10 000 treatments over the first 7 days after treatment. When comparing patients who received ECT with a matched group of mental health patients, those receiving ECT had a relative odds of all-cause mortality in the year after their index course of 0.87 (95% CI 0.79–1.11; P = 0.10), and a relative risk of death from causes other than suicide of 0.79 (95% CI 0.66–0.95; P < 0.01). The similar relative odds of all-cause mortality in the first 30 days after ECT was 1.06 (95% CI 0.65–1.73) for all-cause mortality, and 1.02 (95% CI 0.58–1.8) for all-cause mortality excluding suicide deaths. Conclusions There was no evidence of elevated or excess mortality after ECT. There was some indication that mortality may be reduced in patients receiving ECT compared with similar patients who do not receive ECT.

Efficacy of hyperbaric oxygen combined with escitalopram in depression and its effect on cognitive function

Article

Full-text available

Apr 2021

Objective: To investigate the efficacy of hyperbaric oxygen (HBO) combined with escitalopram in patients with depression and its effect on cognitive function. Methods: From 2016 to 2018, seventy patients with depression aged 18-65 years treated in Affiliated Hospital of Hebei University were selected. Seventy patients with depression meeting the diagnostic criteria of ICD-10 were selected and randomly divided into control group and observation group using a random number table, with 35 patients in each group. The control group was treated with escitalopram, while the observation group was additionally treated with HBO on this basis. The patients were assessed using the Hamilton Depression Scale (HAMD) and Montreal Cognitive Assessment Scale (MoCA) before treatment and two, four and six weeks after treatment. Results: Two weeks after treatment, HAMD score showed a statistically significant difference between the two groups (P < 0.05). No statistically significant differences were found in HAMD score between the two groups four and six weeks after treatment (P > 0.05). Four and six weeks after treatment, MoCA score presented statistically significant differences between the two groups (P < 0.05). Conclusion: Escitalopram combined with HBO in the treatment of depression presents rapid efficacy and a certain effect in improving cognitive function.

Interaction effects of diabetes and brain-derived neurotrophic factor on suicidal ideation in patients with acute coronary syndrome

Preprint

Full-text available

Mar 2021

Background Acute coronary syndrome (ACS) is associated with an increased risk of suicide. Although both diabetes and the brain-derived neurotrophic factor (BDNF) pathway are closely related to ACS and suicide, the effects of these factors on suicidal behavior in ACS patients have not been assessed. The aim of this study was to investigate the individual and interaction effects of diabetes and BDNF-related markers, namely the serum BDNF (sBDNF) level and the BDNF Val66Met polymorphism, on suicidal ideation (SI) in ACS patients. Methods The presence of diabetes was ascertained, and sBDNF levels and the presence of the BDNF Val66Met polymorphism were measured in 969 patients within 2 weeks after an ACS episode. Among these patients, 711 were followed up at 1 year after the ACS episode. SI was evaluated using the relevant items of the Montgomery–Åsberg Depression Rating Scale at baseline (acute SI) and the 1-year follow-up (chronic SI). Results Significant individual effects of low sBDNF levels were found on acute SI. The presence of both diabetes and a low sBDNF level or the BDNF Met/Met genotype was associated with acute SI, with multivariate logistic regression analyses revealing significant interaction effects. The highest frequency of chronic SI was seen in diabetic patients with an sBDNF level in the lowest tertile or with the BDNF Met/Met genotype, although the interaction terms were not statistically significant. Conclusions Combining diabetes and BDNF-related markers, such as the sBDNF level and the BDNF Val66Met polymorphism, might provide a useful predictor of acute SI in patients with ACS.

Drug adherence and psychosocial characteristics of patients presenting with hypertensive urgency at the emergency department

Article

Mar 2021

Objective: To identify potentially targetable psychosocial factors associated with nonadherence to prescribed antihypertensive medications in patients presenting with hypertensive urgencies at an emergency department. Methods: This prospective study included patients treated with antihypertensive drugs who presented with hypertensive urgencies (SBP ≥180 mmHg and/or DBP ≥110 mmHg) at the emergency department of a tertiary referral clinic between April 2018 and April 2019. Health literacy was assessed using the Newest Vital Sign test. The Hospital Anxiety and Depression Scale (HADS) was used to quantify symptoms of anxiety and depression. Patients were classified nonadherent if less than 80% of the prescribed antihypertensive drugs were detectable in urine or plasma using liquid chromatography-high-resolution mass spectrometry. Results: A total of 104 patients (62% women) presenting with hypertensive urgencies with a median SBP of 200 mmHg (IQR 190-212) and DBP of 97.5 mmHg (IQR 87-104) were included. Twenty-five patients (24%) were nonadherent to their antihypertensive medication. Nonadherent patients were more often men (66 versus 23%, P = 0.039), prescribed higher numbers of antihypertensive drugs (median 3, IQR 3-4 versus 2, IQR 1-3; P < 0.001), and more often treated with calcium channel blockers (76 versus 25%; P < 0.001) and/or diuretics (64 versus 40%; P = 0.030). There was no difference in health literacy (P = 0.904) or the scores on the HADS subscales for depression (P = 0.319) and anxiety (P = 0.529) between adherent and nonadherent patients. Conclusion: Male sex, higher numbers of antihypertensive drugs, and treatment with diuretics and/or calcium channel blockers were associated with nonadherence. We did not identify a specific psychosocial characteristic associated with nonadherence.

Changes in serum serotonin levels in patients with acute coronary syndrome and stable angina undergoing percutaneous coronary intervention

Article

Full-text available

Dec 2020
J INT MED RES

Objective Activated platelets release serotonin, causing platelet aggregation and vasoconstriction. Serotonin levels were investigated in patients with acute coronary syndrome (ACS) and chronic stable angina (CSA) treated with percutaneous coronary intervention (PCI). Methods Consecutive patients undergoing PCI for either ACS or CSA were enrolled between July 2009 and April 2010. Patients were pre-treated with dual antiplatelet agents (aspirin and clopidogrel) before PCI. Serum serotonin levels, measured at baseline, pre- and post-PCI, and at 90 min, and 6, 12, 24 and 48 h following PCI, were compared between ACS and CSA groups. Results Sixty-three patients with ACS and 60 with CSA were included. Overall baseline characteristics were similar between the two groups. Serotonin levels at post-PCI (55.2 ± 120.0 versus 20.1 ± 24.0) and at peak (regardless of timepoint; 94.0 ± 170.9 versus 38.8 ± 72.3) were significantly higher in the ACS versus CSA group. At 90 min and 6, 24 and 48 h post-PCI, serum serotonin was numerically, but not significantly, higher in patients with ACS. Serotonin levels fluctuated in both groups, showing an initial rise and fall, rebound at 24 h and drop at 48 h post-PCI. Conclusions In patients undergoing PCI, serum serotonin was more elevated in patients with ACS than those with CSA, suggesting the need for more potent and sustained platelet inhibition, particularly in patients with ACS.

Recurrent versus new-onset depressive symptoms: Relationships with biomarkers of cardiovascular health following acute coronary syndrome

Article

Jan 2021
J PSYCHOSOM RES

Objective New-onset depressive symptoms commonly arise among persons without a history of major depressive disorder (MDD) in the setting of acute medical illness. Although depressive symptoms in general are associated with alterations in prognostic biomarkers following acute coronary syndrome (ACS), the nature of specifically new-onset depressive symptoms is less well-characterized. It is unclear whether such symptoms neurobiologically resemble recurrent symptoms of MDD or instead represent a distinct condition. In this exploratory analysis, we aimed to examine the effects of prior MDD history on the relationships between post-ACS depressive symptoms and cardiovascular biomarkers. Methods One-hundred sixty-four participants attended study visits 2 weeks and 6 months after ACS to complete self-report measures and provide biomarker samples. MDD history was identified by a psychiatrist through systematic electronic medical record review. Generalized estimating equations were performed to examine the moderating effects of MDD history on concurrent relationships between depressive symptoms and several biomarkers (endothelin-1, soluble intercellular adhesion molecule-1, high-sensitivity C-reactive protein, interleukin-6, and tumor necrosis factor-alpha). Results Twenty percent (n = 33) of participants had a history of MDD. Depressive symptoms were more strongly associated with levels of endothelin-1 in patients with prior MDD compared to those without (B = 0.024, 95% CI [0.005, 0.043], p = .012), adjusting for age, sex, medical factors, and anxiety. MDD history did not moderate relationships between depressive symptoms and other biomarkers. Conclusion Recurrent post-ACS depressive symptoms are more strongly associated with elevated endothelin-1 levels than new-onset symptoms. Further work is needed to clarify the mechanism and clinical implications of this relationship.

Prävalenzen von psychiatrischen Komorbiditäten bei somatisch behandelten Patienten an Allgemeinkrankenhäusern - ein Vergleich des Liaisonmodells zum Konsiliarmodell

Thesis

Jan 2020

Juliane Dorothee Gschoßmann

Hintergrund und Ziele: Mit der Entwicklung zu einem holistischen Patientenbild und dem Ziel der optimalen medizinischen Versorgung findet seit den 70er Jahren eine vermehrte Integration der psychischen Betreuung in deutsche Allgemeinkranken-häuser statt. Möglich wird dies durch das Liaison- bzw. das Konsiliarmodell. Bei einer Prävalenz psychischer Störungen von ca. 30% in der deutschen Allgemein-bevölkerung bzw. auf somatischen Stationen ist ein erheblicher Bedarf an professi-oneller Betreuung zu verzeichnen. Psychische Störungen können als Ursache, Re-aktion oder Komorbidität bei somatischer Krankheit auftreten. Die dominierenden psychiatrischen Diagnosen sind Depression, Delirium, Demenz, Somatisierungs-störungen, Anpassungsstörungen, substanzbezogene Störungen. Psychische Stö-rungen können weitreichende Folgen auf die Diagnostik, die Therapie und das Be-handlungsergebnis haben. Nur ca. 19% der Menschen mit psychischen Krankhei-ten suchen bewusst professionelle Hilfe auf. Zusätzlich ist die Versorgung psychi-scher Störungen in Allgemeinkrankenhäusern häufig noch ungenügend. Aktuelle, vergleichende Studien des Liaison- und Konsiliarmodells deutscher bzw. westeu-ropäischer Patientenpopulationen fehlen bisher. Ziel der Arbeit war es das Über-weisungsverhalten, das Patientenprofil, die Prävalenzen und die Behandlungs-empfehlungen der beiden Modelle miteinander zu vergleichen und anschließend anhand der Studienergebnisse eine Empfehlung der optimalen psychiatrischen Betreuung psychisch kranker Patienten in deutschen Allgemeinkrankenhäusern zu erstellen. Methoden: In dieser retrospektiven, nicht-interventionellen, multizentrischen Studie wurden 890 stationäre Krankenhauspatienten, die sich primär aufgrund eines so-matischen Leidens vorstellten, auf psychiatrische Komorbiditäten untersucht. Hier-für wurden zwei unterschiedliche psychiatrische Betreuungsmethoden, das Liai-son- sowie das Konsiliarmodell, miteinander verglichen. Es wurden zum einen 545 Patientendaten des Klinikum Forchheim ausgewertet, in welchem die Erkrank-ten zweimal wöchentlich zu festen Sprechstundenzeiten nach dem Liaisonprinzip betreut wurden. Zum anderen wurden die Daten von 345 Patienten, welche im Uni-versitätsklinikum der Friedrich-Alexander-Universität Erlangen-Nürnberg nach dem Konsiliarmodell betreut wurden, analysiert. Die jeweilige Indikation für ein psychiat-risches Konsil stellte der somatisch behandelnde Arzt. Dieser initiierte auch die psychiatrische Betreuung. Es handelte sich in mehr als 90% der Fälle um drei iden-tische Psychiater. Der darauffolgende Konsilablauf entsprach im Wesentlichen dem eines Routinekonsils und war an beiden Krankenhäusern identisch. Die Diagnosen wurden vom Psychiater orientierend an der ICD-10 gestellt. Die statistische Aus-wertung der erhobenen Patientendaten erfolgte durch SPSS Statistics 23. Um die Ergebnisse der beiden Krankenhäuser einander gegenüberstellen zu können, be-diente man sich der deskriptiven Analyse bzw. anderer adäquater statistischer Me-thoden wie der Regressionsanalyse. Ergebnisse und Beobachtungen: Das Durchschnittsalter aller Studienteilnehmer betrug 64,7 Jahre, 59,9% waren weiblich. 82,5% der Patienten besaßen eine psy-chiatrische Vordiagnose. 90,8% der Patienten wurden von internistischen Stationen überwiesen. Die häufigste Diagnose waren Affektstörungen (39,3%), gefolgt von organischen psychischen Störungen (18,9%), von Alkohol-induzierten psychischen Störungen (11,3%) und von Reaktionen auf starken Stress bzw. Anpassungsstö-rungen (10,4%). Unter Suizidalität litten 11,1% (9,0% latent, 2,2% akut) der Patien-ten. Bei 5,5% der Patienten wurde keine psychische Störung festgestellt. In über 90% der Fälle genügte eine einzige psychiatrische Konsilsitzung. Am häufigsten wurden Antidepressiva (27,3%; 17,4% Selektive Serotonin-Wiederaufnahmehemmer, 4,0% Trizyklische Antidepressiva) verschrieben. Im An-schluss an die Konsilbehandlung wurde zur weiterführenden Behandlung 41% der Patienten eine ambulante psychiatrische Therapie empfohlen. Das Durchschnittsal-ter war im Liaisonmodell mit 69 Jahren höher als im Konsiliarmodell mit 57 Jahren. Die Überweisungsrate im Konsiliarmodell war signifikant niedriger als im Liaison-modell (3,7% vs. 6,8%, p<0.001). Die somatischen Fachärzte der entsprechenden Stationen stellten im Konsiliarmodell in 98,5% der Fälle, im Liaisonmodell in 88,3% der Fälle korrekterweise eine Konsilanfrage an den psychiatrischen Dienst (p<0.001). Die Konsiliarmodell-Patienten wiesen häufiger schwere Erkrankungen auf und benötigten daher komplexere Therapien wie beispielsweise signifikant häufigere Einweisungen auf die psychiatrische Intensivstation (28,7% vs. 0,4%, p<0.001). Affektive Störungen waren im Konsiliarmodell häufiger anzutreffen (46,6% vs. 34,8%, p<0.001). Organische psychische Störungen waren im Liaison-modell signifikant häufiger anzutreffen (24,0% vs. 10,3%, p<0.001). Besonders her-vorzuheben ist der hoch signifikante Unterschied der Suizidalität im Liaison- im Vergleich zum Konsiliarmodell (7,8% vs. 16,3%, p<0.001). Das Ausbleiben einer psychiatrischen Diagnose kam im Liaisonmodell vergleichsweise häufig vor (8,4% vs. 0,6%, p<0.001). Selektive Serotonin-Wiederaufnahmehemmer wurden signifi-kant häufiger im Liaisonmodell verordnet (23,5% vs. 7,8%). Benzodiazepine wur-den wiederum häufiger im Konsiliarmodell verschrieben (38,6% vs. 20,0%).

El vínculo inflamatorio entre la enfermedad coronaria y la depresión

Article

Full-text available

Feb 2020
REV MED CHILE

Alvaro Cavieres

A narrative review of the evidence regarding the role of inflammation in the pathophysiology of coronary heart disease and depression is presented. As a common pathogenic factor, inflammation could explain the frequent association of both diseases. We discuss the benefit of exercise and diet modifications in both conditions and the effectiveness and safety of selective serotonin reuptake inhibitors. Finally, we recommend screening for depressive symptoms in coronary patients and the search of cardiovascular risk factors in people with depression.

Depression and the Effect of Sertraline on Inflammatory Biomarkers in Patients with Non-Dialysis CKD

Article

Apr 2020

Background Inflammatory biomarkers are elevated in patients with CKD and associated with poor outcomes. Major depressive disorder (MDD) is prevalent in CKD and associated with inflammation. No studies investigated the effect of MDD treatment on plasma inflammatory biomarkers in patients with nondialysis CKD. Methods In a prespecified analysis of the randomized, double-blind CKD Antidepressant Sertraline Trial, we investigated whether treatment with sertraline versus placebo or response to treatment would affect plasma levels of albumin, prealbumin, IL-6, and high-sensitivity C-reactive protein (hsCRP), measured at baseline and after 12 weeks of treatment. We also explored whether somatic versus nonsomatic depressive symptoms, measured using the Quick Inventory of Depressive Symptomatology, and quality-of-life subscales, measured using the Kidney Disease Quality of Life Short Form, were associated with baseline levels of these inflammatory biomarkers. Results Of the 193 participants, mean age was 58.4 (SD 13) years and 58% were black, 42% were white, and 18% were Hispanic. Higher baseline hsCRP correlated with somatic depressive symptoms ( r =0.21; P =0.01), fatigue ( r =0.22; P =0.005), and poorer physical functioning ( r =−0.26; P =0.001). There was no change in hsCRP in the sertraline group. hsCRP increased in placebo nonresponders from baseline (median, 3.7 mg/L; interquartile range [IQR], 1.7–10.0 mg/L) to exit (median, 4.9 mg/L; IQR, 1.8–8.8 mg/L; P =0.01). The change from baseline to exit differed between placebo responders (median, −0.4 mg/L; IQR, −9.3 to 0.2 mg/L) and nonresponders (median, 0.8 mg/L; IQR, −0.1 to 3.9 mg/L; P =0.008). There were no differences in changes in albumin, prealbumin, or IL-6 from baseline in any group. Conclusions Among patients with CKD and MDD, hsCRP correlated with somatic symptoms of depression and fatigue, but not with nonsomatic symptoms. Sertraline treatment was not associated with a longitudinal change in hsCRP from baseline regardless of treatment effect on depressive symptoms, but those who failed to respond to placebo had an increase in hsCRP over time. This area deserves further investigation. Clinical Trial registry name and registration number CKD Antidepressant Sertraline Trial (CAST), NCT00946998 .

Long-term cardiac outcomes of depression screening, diagnosis and treatment in patients with acute coronary syndrome: the DEPACS study

Article

Full-text available

Jan 2020

Background To investigate the impacts of depression screening, diagnosis and treatment on major adverse cardiac events (MACEs) in acute coronary syndrome (ACS). Methods Prospective cohort study including a nested 24-week randomised clinical trial for treating depression was performed with 5–12 years after the index ACS. A total of 1152 patients recently hospitalised with ACS were recruited from 2006 to 2012, and were divided by depression screening and diagnosis at baseline and 24-week treatment allocation into five groups: 651 screening negative (N), 55 screening positive but no depressive disorder (S), 149 depressive disorder randomised to escitalopram (E), 151 depressive disorder randomised to placebo (P) and 146 depressive disorder receiving medical treatment only (M). Results Cumulative MACE incidences over a median 8.4-year follow-up period were 29.6% in N, 43.6% in S, 40.9% in E, 53.6% in P and 59.6% in M. Compared to N, screening positive was associated with higher incidence of MACE [adjusted hazards ratio 2.15 (95% confidence interval 1.63–2.83)]. No differences were found between screening positive with and without a formal depressive disorder diagnosis. Of those screening positive, E was associated with a lower incidence of MACE than P and M. M had the worst outcomes even compared to P, despite significantly milder depressive symptoms at baseline. Conclusions Routine depression screening in patients with recent ACS and subsequent appropriate treatment of depression could improve long-term cardiac outcomes.

A Systematic Review and Meta-Analysis of Depression and Protein-Energy Wasting in Kidney Disease

Article

Full-text available

Dec 2019

Introduction Depression comorbid with chronic disease may be mediated by inflammation. We sought to characterize relationships between inflammatory biomarkers and depressive symptoms in patients with chronic kidney disease and end-stage kidney disease. Methods A systematic literature search was conducted by 2 authors up to March 19, 2019, for studies of patients with chronic kidney disease or end-stage kidney disease evaluating circulating inflammatory biomarkers associated with depression of chronic disease: albumin, C-reactive protein (CRP), high-sensitivity CRP, interleukin-6 (IL-6), tumor necrosis factor-α, and interleukin-1. Standardized mean differences in biomarkers between individuals with and without depression were computed and analyzed using mixed effects models. Correlations between biomarkers and the severity of depressive symptoms were computed. Results Thirty-four studies (5652 participants) compared biomarkers between depressed and nondepressed individuals. Individuals with depression had lower albumin levels (standardized mean difference, −0.37; 95% confidence interval [CI], −0.61 to −0.13), higher CRP levels (standardized mean difference, 0.76; 95% CI, 0.16–1.37), and higher IL-6 levels (standardized mean difference, 0.42; 95% CI, 0.21–0.63). Studies were heterogeneous for albumin, CRP, high-sensitivity CRP, and tumor necrosis factor-α. Twenty-three studies (3047 participants) investigated correlations between biomarkers and depressive symptoms. The severity of depressive symptoms correlated with albumin (Z = −0.25; 95% CI, −0.36 to −0.14), high-sensitivity CRP (Z = 0.28; 95% CI, 0.13–0.43), and IL-6 (Z = 0.34; 95% CI, 0.18–0.49). There was heterogeneity across studies of IL-6. Only 6 studies (321 participants) investigated the effect of antidepressant treatment on inflammatory biomarkers, which was insufficient to combine in meta-analysis. Conclusion Lower albumin and higher IL-6 were associated with both the presence and severity of depression, CRP with the presence of depression, and high-sensitivity CRP with the severity of depressive symptoms. The effect of interventions to lower inflammation in patients with kidney disease and depression deserves investigation.

Investigating Exercise for Anxiety and Depression Treatment: A Case Report

Article

Full-text available

Jun 2019

Mechanisms and treatment of late-life depression

Article

Full-text available

Dec 2019

George S Alexopoulos

Depression predisposes to medical illnesses and advances biological aging indicated by shorter telomere length, accelerated brain aging and advanced epigenetic aging. Medical illnesses also increase the risk of late-life depression. The reciprocal relationships of depression with aging-related and disease-related processes have generated pathogenetic hypotheses and provided treatment targets. Targeting risk factors of vascular disease in mid-life is a logical approach in prevention of vascular depression. The depression-executive dysfunction and the vascular depression syndromes have clinical presentations and neuroimaging findings consistent with frontostriatal abnormalities. Dopamine D2/3 agonists are effective in depression of Parkinson’s disease and their efficacy needs to be assessed in these two syndromes. Computerized cognitive remediation targeting functions of the cognitive control network may improve both executive functions and depressive symptoms of late-life major depression. Significant progress has been made in neurostimulation treatments in depressed younger adults. TMS targeting deep structures responsible for mood regulation is well tolerated by older adults and its efficacy in syndromes of late-life depression needs to be studied. Efficacious psychotherapies for late-life depression exist, but are underutilized in part because of their complexity. Streamlined, stepped psychotherapies targeting behaviors assumed to result from dysfunction of brain networks implicated in late-life depression can be easy to learn and have potential for dissemination. However, their effectiveness needs further investigation. Depression increases the risk of dementing disorders. Antidepressants are rather ineffective in treating depression of demented patients, but long-term use of antidepressants may reduce the risk of dementia. However, confirmation studies are needed.

Selbstwirksamkeit und postoperative psychische Prozesse nach ICD-Impantation

Article

Jan 2010

Claudia Wirsching

Long-term proarrhythmic pharmacotherapy among patients with congenital long QT syndrome and risk of arrhythmia and mortality

Article

May 2019
EUR HEART J

Aims: It is Class I recommendation that congenital long QT syndrome (cLQTS) patients should avoid drugs that can cause torsades de pointes (TdP). We determined use of TdP risk drugs after cLQTS diagnosis and associated risk of ventricular arrhythmia and all-cause mortality. Methods and results: Congenital long QT syndrome patients (1995-2015) were identified from four inherited cardiac disease clinics in Denmark. Individual-level linkage of nation-wide registries was performed to determine TdP risk drugs usage (www.crediblemeds.org) and associated risk of ventricular arrhythmias and all-cause mortality. Risk analyses were performed using Cox-hazards analyses. During follow-up, 167/279 (60%) cLQTS patients were treated with a TdP risk drug after diagnosis. Most common TdP risk drugs were antibiotics (34.1%), proton-pump inhibitors (15.0%), antidepressants (12.0%), and antifungals (10.2%). Treatment with a TdP risk drug decreased 1 year after diagnosis compared with 1 year before (28.4% and 23.2%, respectively, P < 0.001). Five years after diagnosis, 33.5% were in treatment (P < 0.001). Risk factors for TdP risk drug treatment were age at diagnosis (5-year increment) [hazard ratio (HR) = 1.07, confidence interval (CI) 1.03-1.11] and previous TdP risk drug treatment (HR = 2.57, CI 1.83-3.61). During follow-up, nine patients were admitted with ventricular arrhythmia (three were in treatment with a TdP risk drug). Eight patients died (four were in treatment with a TdP risk drug). No significant association between TdP risk drug use and ventricular arrhythmias or all-cause mortality was found (P = 0.53 and P = 0.93, respectively), but events were few. Conclusion: Torsades de pointes risk drug usage was common among cLQTS patients after time of diagnosis and increased over time. A critical need for more awareness in prescribing patterns for this high-risk patient group is needed.

Metabolic Syndrome and Depression

Chapter

Apr 2024

Bernd Löwe

Depression and metabolic syndrome have become more common in recent decades and co-occur more frequently than by chance. Both are risk factors for cardiovascular mortality, and can mutually reinforce each other in a vicious cycle through factors such as inactivity, social withdrawal, malnutrition, chronic stress, motivational difficulties in behavioral changes, and metabolic parameters. Therefore, diagnostic and therapeutic measures must simultaneously consider both metabolic syndrome and depression. The goal of treatment is not only remission of depression but also to enable patients to successfully and independently manage the health challenges of metabolic syndrome.

Depression

Chapter

Nov 2022

Major depressive disorder (MDD) is common among patients with chronic kidney disease (CKD) and end‐stage kidney disease, more so than in other chronic conditions, and is associated with a range of adverse clinical outcomes. It is not known whether depression in patients with CKD is different from depression that is seen in individuals without a comorbid chronic medical condition, and in particular whether depressive symptom severity and the efficacy of treatment is modified by decrements in kidney function. Studies of patients with CKD and end‐stage kidney disease have identified vastly different estimates of the prevalence of depression. Compared to studies assessing depression among hemodialysis populations, there are limited studies among individuals receiving peritoneal dialysis and the available studies involve relatively small samples of patients. The studies assessing the prevalence of depression among kidney transplant populations are predominately small single‐center samples.

Medikamentenadhärenz und psychosoziale Charakteristika von Patienten mit einer hypertensiven Entgleisung an der Notaufnahme

Thesis

Jan 2022

Julius Christian Glasmacher

Metabolisches Syndrom und Depression

Chapter

Aug 2022

Bernd Löwe

Depression und metabolisches Syndrom sind in den letzten Jahrzehnten häufiger geworden und treten überzufällig häufig gemeinsam auf. Depression und metabolisches Syndrom, beides Risikofaktoren für kardiovaskuläre Mortalität, können sich im Sinne eines Circulus vitiosus durch Faktoren wie Inaktivität, sozialen Rückzug, Fehlernährung, chronischen Stress, motivationale Schwierigkeiten bei Verhaltensänderungen und metabolische Parameter wechselseitig verstärken. Deshalb müssen diagnostische und therapeutische Maßnahmen simultan das metabolische Syndrom und die Depression berücksichtigen. Ziel der Behandlung ist nicht nur eine Remission der Depression, sondern auch, den Patienten in die Lage zu versetzen, die gesundheitlichen Herausforderungen des metabolischen Syndroms erfolgreich und eigenverantwortlich zu managen.

Involvement of the brain–heart axis in the link between PTSD and cardiovascular disease

Article

Full-text available

Jun 2022
DEPRESS ANXIETY

Posttraumatic stress disorder (PTSD) has long been associated with a heightened risk of cardiovascular disease (CVD). A number of mechanisms have been implicated to underlie this brain–heart axis relationship, such as altered functioning of the autonomic nervous system and increased systemic inflammation. While neural alterations have repeatedly been observed in PTSD, they are rarely considered in the PTSD–CVD link. The brain–heart axis is a pathway connecting frontal and limbic brain regions to the brainstem and periphery via the autonomic nervous system and it may be a promising model for understanding CVD risk in PTSD given its overlap with PTSD neural deficits. We first provide a summary of the primary mechanisms implicated in the association between PTSD and CVD. We then review the brain–heart axis and its relevance to PTSD, as well as findings from PTSD trials demonstrating that a number of PTSD treatments have effects on areas of the brain–heart axis. Finally, we discuss sex considerations in the PTSD–CVD link. A critical next step in this study is to determine if PTSD treatments that affect the brain–heart axis (e.g., brain stimulation that improves autonomic function) also reduce the risk of CVD.

2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

Article

Apr 2022

Aim The “2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure” replaces the “2013 ACCF/AHA Guideline for the Management of Heart Failure” and the “2017 ACC/AHA/HFSA Focused Update of the 2013 ACCF/AHA Guideline for the Management of Heart Failure.” The 2022 guideline is intended to provide patient-centric recommendations for clinicians to prevent, diagnose, and manage patients with heart failure. Methods A comprehensive literature search was conducted from May 2020 to December 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from MEDLINE (PubMed), EMBASE, the Cochrane Collaboration, the Agency for Healthcare Research and Quality, and other relevant databases. Additional relevant clinical trials and research studies, published through September 2021, were also considered. This guideline was harmonized with other American Heart Association/American College of Cardiology guidelines published through December 2021. Structure Heart failure remains a leading cause of morbidity and mortality globally. The 2022 heart failure guideline provides recommendations based on contemporary evidence for the treatment of these patients. The recommendations present an evidence-based approach to managing patients with heart failure, with the intent to improve quality of care and align with patients’ interests. Many recommendations from the earlier heart failure guidelines have been updated with new evidence, and new recommendations have been created when supported by published data. Value statements are provided for certain treatments with high-quality published economic analyses.

Time for united action on depression: a Lancet-World Psychiatric Association Commission

Article

Feb 2022
LANCET

Psychological and pharmacological interventions for depression in patients with coronary artery disease

Article

Dec 2021
COCHRANE DB SYST REV

Background: Depression occurs frequently in individuals with coronary artery disease (CAD) and is associated with a poor prognosis. Objectives: To determine the effects of psychological and pharmacological interventions for depression in CAD patients with comorbid depression. Search methods: We searched the CENTRAL, MEDLINE, Embase, PsycINFO, and CINAHL databases up to August 2020. We also searched three clinical trials registers in September 2021. We examined reference lists of included randomised controlled trials (RCTs) and contacted primary authors. We applied no language restrictions. Selection criteria: We included RCTs investigating psychological and pharmacological interventions for depression in adults with CAD and comorbid depression. Our primary outcomes included depression, mortality, and cardiac events. Secondary outcomes were healthcare costs and utilisation, health-related quality of life, cardiovascular vital signs, biomarkers of platelet activation, electrocardiogram wave parameters, non-cardiac adverse events, and pharmacological side effects. Data collection and analysis: Two review authors independently examined the identified papers for inclusion and extracted data from the included studies. We performed random-effects model meta-analyses to compute overall estimates of treatment outcomes. Main results: Thirty-seven trials fulfilled our inclusion criteria. Psychological interventions may result in a reduction in end-of-treatment depression symptoms compared to controls (standardised mean difference (SMD) -0.55, 95% confidence interval (CI) -0.92 to -0.19, I2 = 88%; low certainty evidence; 10 trials; n = 1226). No effect was evident on medium-term depression symptoms one to six months after the end of treatment (SMD -0.20, 95% CI -0.42 to 0.01, I2 = 69%; 7 trials; n = 2654). The evidence for long-term depression symptoms and depression response was sparse for this comparison. There is low certainty evidence that psychological interventions may result in little to no difference in end-of-treatment depression remission (odds ratio (OR) 2.02, 95% CI 0.78 to 5.19, I2 = 87%; low certainty evidence; 3 trials; n = 862). Based on one to two trials per outcome, no beneficial effects on mortality and cardiac events of psychological interventions versus control were consistently found. The evidence was very uncertain for end-of-treatment effects on all-cause mortality, and data were not reported for end-of-treatment cardiovascular mortality and occurrence of myocardial infarction for this comparison. In the trials examining a head-to-head comparison of varying psychological interventions or clinical management, the evidence regarding the effect on end-of-treatment depression symptoms is very uncertain for: cognitive behavioural therapy compared to supportive stress management; behaviour therapy compared to person-centred therapy; cognitive behavioural therapy and well-being therapy compared to clinical management. There is low certainty evidence from one trial that cognitive behavioural therapy may result in little to no difference in end-of-treatment depression remission compared to supportive stress management (OR 1.81, 95% CI 0.73 to 4.50; low certainty evidence; n = 83). Based on one to two trials per outcome, no beneficial effects on depression remission, depression response, mortality rates, and cardiac events were consistently found in head-to-head comparisons between psychological interventions or clinical management. The review suggests that pharmacological intervention may have a large effect on end-of-treatment depression symptoms (SMD -0.83, 95% CI -1.33 to -0.32, I2 = 90%; low certainty evidence; 8 trials; n = 750). Pharmacological interventions probably result in a moderate to large increase in depression remission (OR 2.06, 95% CI 1.47 to 2.89, I2 = 0%; moderate certainty evidence; 4 trials; n = 646). We found an effect favouring pharmacological intervention versus placebo on depression response at the end of treatment, though strength of evidence was not rated (OR 2.73, 95% CI 1.65 to 4.54, I2 = 62%; 5 trials; n = 891). Based on one to four trials per outcome, no beneficial effects regarding mortality and cardiac events were consistently found for pharmacological versus placebo trials, and the evidence was very uncertain for end-of-treatment effects on all-cause mortality and myocardial infarction. In the trials examining a head-to-head comparison of varying pharmacological agents, the evidence was very uncertain for end-of-treatment effects on depression symptoms. The evidence regarding the effects of different pharmacological agents on depression symptoms at end of treatment is very uncertain for: simvastatin versus atorvastatin; paroxetine versus fluoxetine; and escitalopram versus Bu Xin Qi. No trials were eligible for the comparison of a psychological intervention with a pharmacological intervention. Authors' conclusions: In individuals with CAD and depression, there is low certainty evidence that psychological intervention may result in a reduction in depression symptoms at the end of treatment. There was also low certainty evidence that pharmacological interventions may result in a large reduction of depression symptoms at the end of treatment. Moderate certainty evidence suggests that pharmacological intervention probably results in a moderate to large increase in depression remission at the end of treatment. Evidence on maintenance effects and the durability of these short-term findings is still missing. The evidence for our primary and secondary outcomes, apart from depression symptoms at end of treatment, is still sparse due to the low number of trials per outcome and the heterogeneity of examined populations and interventions. As psychological and pharmacological interventions can seemingly have a large to only a small or no effect on depression, there is a need for research focusing on extracting those approaches able to substantially improve depression in individuals with CAD and depression.

Adverse reactions of antidepressant drugs and their application in patients with cardiovascular diseases

Article

Oct 2020
J Cent S Univ Med Sci

Depression has a high incidence in patients with cardiovascular diseases (CVD) and shows adverse effects on their life quality and prognosis. With the advent of new antidepressant drugs, oral antidepressant drugs are increasingly used in CVD patients with depression, and their efficacy and safety have attracted attention. Commonly used antidepressant drugs have many adverse reactions. When applying antidepressant drugs in CVD patients, we should pay special attention to their cardiovascular adverse reactions and their interaction drugs with commonly used CVD drugs. Clinicians should comprehensively evaluate and select appropriate antidepressant drugs for patients.

The Cardiovascular Effects of Newer Antidepressants in Older Adults and Those With or At High Risk for Cardiovascular Diseases

Article

Nov 2020

Depression is common in older adults and those with cardiovascular disease. Although selective serotonin reuptake inhibitors generally have been shown to be safe to treat depression in these patients, it is important to identify additional antidepressants when selective serotonin reuptake inhibitors are not effective. This qualitative narrative review summarizes what is known about the cardiovascular side effects of some of the newer antidepressants. Twelve novel non-selective serotonin reuptake inhibitor antidepressants were identified from the literature: venlafaxine, desvenlafaxine, duloxetine, milnacipran, levomilnacipran, mirtazapine, bupropion, vilazodone, vortioxetine, agomelatine, moclobemide, and ketamine–esketamine. A search restricted to publications written in English was conducted in PubMed and Google Scholar with the following search criteria: the specific antidepressant AND (QT OR QTc OR “heart rate” OR “heart rate variability” OR “hypertension” OR “orthostatic hypotension” OR “cardiovascular outcomes” OR “arrhythmia” OR “myocardial infarction” OR “cardiovascular mortality”) AND (geriatric OR “older adults” OR “late life depression” OR “cardiovascular disease” OR “hospitalized” OR “hospitalized”). The recommended use, dosing ranges, cardiovascular effects, and general advantages and disadvantages of each of the drugs are discussed. Levomilnacipran and vilazodone have not received enough study to judge their safety in older patients or in those with, or at high risk for, cardiovascular disease. There is at least some evidence for possible adverse events with each of the other newer antidepressants that could be of concern in these patients. Nevertheless, with careful administration and attention to the potential adverse reactions for each drug, these may provide safe effective alternatives for older adults and patients with cardiovascular disease who do not respond to selective serotonin reuptake inhibitor antidepressants. However, more research on the safety and efficacy of these drugs in these specific patient populations is urgently needed.

Psychological distress and cardiovascular disease: An investigation into the epidemiological evidence

Thesis

Jan 2020

Jennifer Welsh

Cardiovascular disease (CVD) is a leading cause of death and a large contributor to disease burden globally. People with symptoms of depression and anxiety (referred to as psychological distress) have an elevated risk of developing CVD and poorer prognosis once it is present. However, the nature of this association remains poorly understood and contested. Therefore, the most effective points of intervention to reduce CVD burden for this group are also unclear. This thesis had two broad aims. First, to contribute to the evidence regarding the independent association between distress and incident CVD by investigating the impact of two common sources of bias. Second, to quantify gaps in CVD preventive treatment to identify opportunities to reduce CVD incidence and improve outcomes for people with distress. To address my first aim, I performed three longitudinal studies. First, I examined the extent to which confounding by physical morbidity overestimates the independent distress-incident CVD association using data from the 45 and Up Study linked to hospitalisation and death records. I found that when restricted to respondents with no or low levels of physical morbidity, the higher rate of CVD associated with higher distress attenuated substantially, suggesting at most, a weak independent distress-CVD association. In studies two and three, I examined the extent to which assessment of distress at a single time point underestimates the independent distress-incident CVD association. I found broad agreement between measures of distress over time using biennial data covering 10-years from the Household, Income and Labour Dynamics of Australia Survey. Using linked 45 and Up Study data, I found that measures of longer-term high distress were associated with a similar elevation in CVD risk relative to single assessments of high distress. However, longer-term high distress was not associated with elevated incident CVD risk after considering personal, behavioural and physical health-related risk factors, also indicative of no, or only a weak, independent distress-CVD association. To address my second aim, I undertook three studies. I examined gaps in primary prevention using data from the 2011-12 Australian Health Survey. The prevalence of high absolute primary CVD risk was higher in those with high compared to low distress, reflecting a poor CVD risk factor profile in this group. Treatment of high absolute risk was low overall, but did not vary in relation to distress. The final two studies examined secondary prevention using 45 and Up Study data linked to hospital and pharmaceutical records. Among respondents admitted to hospital with incident diagnosis of ischaemic heart disease, rates of coronary procedures were generally lower in people with higher compared to lower levels of distress. Among participants with a history of ischaemic heart disease or ischaemic stroke, use of guideline-recommended medications for secondary CVD prevention was lower for those with higher psychological distress. The evidence generated in this thesis suggests that psychological distress might best be considered a marker of CVD risk, rather than a risk factor. Furthermore, the observed gaps in preventive treatments represent opportunities to reduce the disproportionately high rate of CVD events among people with distress.

Effects of antidepressants on QT interval in people with mental disorders

Article

Full-text available

May 2020

Introduction: Drug-induced QT prolongation is associated with higher cardiovascular mortality. Material and methods: We conducted a protocol-based comprehensive review of antidepressant-induced QT prolongation in people with mental disorders. Results: Based on findings from 47 published randomized controlled trials (RCTs), 3 unpublished RCTs, 14 observational studies, 662 case reports of torsades de pointes, and 168 cases of QT prolongation, we conclude that all antidepressants should be used only with licensed doses, and that all patients receiving antidepressants require monitoring of QT prolongation and clinical symptoms of cardiac arrhythmias. Large observational studies suggest increased mortality associated with all antidepressants (RR = 1.62, 95% CI: 1.60-1.63, number of adults: 1,716,552), high doses of tricyclic antidepressants (OR = 2.11, 85% CI 1.10-4.22), selective serotonin reuptake inhibitors (OR = 2.78, 95% CI: 1.24-6.24), venlafaxine (OR = 3.73, 95% CI: 1.33-10.45, number of adults: 4,040), and nortriptyline (OR = 4.60, 95% CI: 1.20-18.40, number of adults: 5,298). Conclusions: Evidence regarding the risk of QT prolongation in children is sparse.

Outcome of patients with acute symptomatic pulmonary embolism and psychiatric disorders

Article

Jun 2020
THROMB RES

Objective To address the association between psychiatric disorders and short-term outcomes after acute symptomatic pulmonary embolism (PE). Methods We identified adults with PE enrolled in the RIETE registry between December 1, 2013, and January 31, 2019. Using multinomial regression, we assessed the association between a history of psychiatric disorders and the outcomes of all-cause mortality, PE-related mortality, and venous thromboembolism recurrence and bleeding rates through 30 days after initiation of treatment. We also examined the impact of depression on all-cause and PE-specific mortality. Results Among 13,120 patients diagnosed with acute PE, 16.1% (2115) had psychiatric disorders and 4.2% died within the first 30-days of follow-up. Patients with psychiatric disorders had increased odds for all-cause (adjusted odds ratio [OR] 1.50; 95% CI, 1.21 to 1.86; P < 0.001) and PE-related mortality (adjusted OR 1.64; 95% CI, 1.09 to 2.48; P = 0.02) compared to those without psychiatric disorders. Multinomial logistic regression showed a non-significant trend toward lower risk of recurrences for patients with psychiatric disorders (adjusted OR 0.49; 95% CI, 0.21 to 1.15; P = 0.10). Psychiatric disorders were not significantly associated with increased odds for major bleeds during follow-up (adjusted OR 1.09; 95% CI, 0.85 to 1.40; P = 0.49). Results were consistent in a sensitivity analysis that only considered patients with a diagnosis of depression. Conclusions In patients with acute PE, history of psychiatric disorders might predict all-cause and PE-related death in the ensuing month after diagnosis.

QTc Prolongation and Psychotropic Medications

Article

Full-text available

Mar 2020

Cardiovascular Manifestations of Panic and Anxiety

Chapter

Jan 2020

Anxiety disorders are prevalent in 10-23% of persons with coronary heart disease (CHD), and are therefore quite commonly encountered in typical cardiology practice settings. Because anxiety disorder patients frequently present to emergency departments and outpatient appointments for atypical cardiovascular symptoms, the accurate identification and treatment of anxiety is therefore a major priority for all persons involved in cardiovascular care. The substantial overlap in subjective cardio-respiratory symptoms shared between anxiety and cardiovascular diseases does little to improve our understanding of this complex association. Herein we describe the complex nature of anxiety disorders such as panic disorder in relation to CHD. Particular attention is paid to overviewing the empirical evidence demonstrating aetiological and prognostic links between anxiety disorders with incident and recurrent cardiovascular diseases respectively. We also discuss potential bio-behavioural mechanisms that lead to atherosclerosis and major cardiovascular event recurrence. This chapter also discusses the extant treatment approaches to anxiety, making suggestions for improving clinical interventions in the population with anxiety and comorbid CHD. After summarizing these facets of the anxiety-CHD link, suggestions are made for future research.

The Maudsley 2003 Prescribing Guidelines

Book

Jun 2003

Screening and Management of Depression in Patients With Cardiovascular Disease: JACC State-of-the-Art Review

Article

Apr 2019
J AM COLL CARDIOL

Depression is a common problem in patients with cardiovascular disease (CVD) and is associated with increased mortality, excess disability, greater health care expenditures, and reduced quality of life. Depression is present in 1 of 5 patients with coronary artery disease, peripheral artery disease, and heart failure. Depression complicates the optimal management of CVD by worsening cardiovascular risk factors and decreasing adherence to healthy lifestyles and evidence-based medical therapies. As such, standardized screening pathways for depression in patients with CVD offer the potential for early identification and optimal management of depression to improve health outcomes. Unfortunately, the burden of depression in patients with CVD is under-recognized; as a result, screening and management strategies targeting depression have been poorly implemented in patients with CVD. In this review, the authors discuss a practical approach for the screening and management of depression in patients with CVD.

Depression as an antecedent to heart disease among women and men in the NHANES I study. National Health and Nutrition Examination Survey

Article

Full-text available

Jun 2000
ARCH INTERN MED

Depression predicts morbidity and mortality among individuals who have coronary heart disease (CHD), and there is increasing evidence that depression may also act as an antecedent to CHD. The studies that have reported a relationship between depression and CHD incidence or mortality either were restricted to men only or analyzed women and men together. The present investigation was conducted to evaluate the differential effect depression may have on CHD incidence and mortality in women and men. We analyzed data from 5007 women and 2886 men enrolled in the first National Health and Nutrition Examination Survey (NHANES I) who were free of CHD at the 1982-1984 interview and who had completed the Center for Epidemiologic Studies Depression Scale (CES-D). Participants were evaluated from the 1982 interview date either until the end of the study (1992 interview date) or until the occurrence of a CHD event. Using CHD incidence and CHD mortality (International Classification of Disease, Ninth Revision, codes 410-414) as the outcome variables, Cox proportional hazards regression models were developed to evaluate the relative risk (RR) of CHD incidence and mortality in the depressed women and men separately, controlling for standard CHD risk factors. The women experienced 187 nonfatal and 137 fatal events, compared with 187 nonfatal and 129 fatal events among the men. The adjusted RR of CHD incidence among depressed women was 1.73 (95% confidence internal [CI], 1.11-2.68) compared with nondepressed women. Depression had no effect on CHD mortality in the women (RR, 0.74; 95% CI, 0.40-1.48). The adjusted RR of CHD incidence among depressed men was 1.71 (95% CI, 1.14-2.56) compared with nondepressed men. Depressed men also had an increased risk of CHD mortality compared with their nondepressed counterparts, with an adjusted RR of 2.34 (95% CI, 1.54-3.56). In this sample, while controlling for possible confounding factors, depression was associated with an increased risk of CHD incidence in both men and women, as well as CHD mortality in men. Depression had no effect on CHD mortality in women.

Patients With Depression Are Less Likely to Follow Recommendations to Reduce Cardiac Risk During Recovery From a Myocardial Infarction

Article

Full-text available

Jun 2000
ARCH INTERN MED

Patients with depression are at greater risk of cardiac death in the first few months after a myocardial infarction (MI). This study was performed to determine whether depression affects adherence to recommendations intended to reduce the risk of cardiac events after an MI. All consenting patients admitted to a university-affiliated teaching hospital during an 18-month period were interviewed 3 to 5 days following an acute MI using the Beck Depression Inventory to assess symptoms of depression and using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition, to determine the presence of major depression and/or dysthymia. Accessible survivors (n=204; 116 men and 88 women) were interviewed by telephone 4 months later using the Medical Outcomes Study Specific Adherence Scale to measure self-reported adherence to recommendations to modify cardiac risk. Patients who were found in the hospital to have symptoms of at least mild to moderate depression (Beck Depression Inventory score > or =10, n=35 [17.2%]) or to have major depression and/or dysthymia (n=31 [15.2%]) reported lower adherence to a low-fat diet, regular exercise, reducing stress, and increasing social support 4 months later. Those with major depression and/or dysthymia also reported taking medications as prescribed less often than those without major depression and/or dysthymia. Diabetic patients with major depression and/or dysthymia were less likely to follow a diet for patients with diabetes than diabetic patients without depression. Patients with depression following an acute MI are less likely to adhere to recommended behavior and lifestyle changes intended to reduce the risk of subsequent cardiac events. This finding could explain why depression in the hospital is related to long-term prognosis in patients recovering from an MI.

Depressive symptoms and risks of coronary heart disease and mortality in elderly Americans. Cardiovascular Health Study Collaborative Research Group

Article

Full-text available

Nov 2000
CIRCULATION

Several epidemiological studies have associated depressive symptoms with cardiovascular disease. We investigated whether depressive symptoms constituted a risk for coronary heart disease (CHD) and total mortality among an apparently healthy elderly cohort. In a prospective cohort of 5888 elderly Americans (>/=65 years) who were enrolled in the Cardiovascular Health Study, 4493 participants who were free of cardiovascular disease at baseline provided annual information on their depressive status, which was assessed using the Depression Scale of the Center for Epidemiological Studies. These 4493 subjects were followed for 6 years for the development of CHD and mortality. The cumulative mean depression score was assessed for each participant up to the time of event (maximum 6-year follow-up). Using time-dependent, proportional-hazards models, the unadjusted hazard ratio associated with every 5-unit increase in mean depression score for the development of CHD was 1.15 (P:=0.006); the ratio for all-cause mortality was 1.29 (P:<0.0001). In multivariate analyses adjusted for age, race, sex, education, diabetes, hypertension, cigarette smoking, total cholesterol, triglyceride level, congestive heart failure, and physical inactivity, the hazard ratio for CHD was 1.15 (P:=0.006) and that for all-cause mortality was 1.16 (P:=0.006). Among participants with the highest cumulative mean depression scores, the risk of CHD increased by 40% and risk of death by 60% compared with those who had the lowest mean scores. Among elderly Americans, depressive symptoms constitute an independent risk factor for the development of CHD and total mortality.

National Institute of Mental Health Diagnostic Interview Schedule: Its history, characteristics and validity

Article

Apr 1981
ARCH GEN PSYCHIAT

A new interview schedule allows lay interviewers or clinicians to make psychiatric diagnoses according to DSM-III criteria, Feighner criteria, and Research Diagnostic Criteria. It is being used in a set of epidemiological studies sponsored by the National Institute of Mental Health Center for Epidemiological Studies. Its accuracy has been evaluated in a test-retest design comparing independent administrations by psychiatrists and lay interviewers to 216 subjects (inpatients, outpatients, ex-patients, and nonpatients).

Myocardial Infarction Redefined – A Consensus Document of The Joint European Society of Cardiology/American College of Cardiology Committee for the Redefinition of Myocardial Infarction

Article

Sep 2000

Definition of MI. Criteria for acute, evolving or recent MI. Either one of the following criteria satisfies the diagnosis for an acute, evolving or recent MI: 1) Typical rise and gradual fall (troponin) or more rapid rise and fall (CK-MB) of biochemical markers of myocardial necrosis with at least one of the following: a) ischemic symptoms; b) development of pathologic Qwaves on the ECG; c) ECG changes indicative of ischemia (ST segment elevation or depression); or d) coronary artery intervention (e.g., coronary angioplasty). 2) Pathologic findings of an acute MI. Criteria for established MI. Any one of the following criteria satisfies the diagnosis for established MI: 1) Development of new pathologic Q waves on serial ECGs. The patient may or may not remember previous symptoms. Biochemical markers of myocardial necrosis may have normalized, depending on the length of time that has passed since the infarct developed. 2) Pathologic findings of a healed or healing MI.

Effects of Clopidogrel in addition to Aspirin in patients with Acute Coronary Syndromes without ST-Segment Elevation. The Clopidogrel in unstable Angina to prevent Recurrent Events Trial Investigators (CURE), 494–502

Article

Apr 2002

PK Satpathy

Prognostic importance of concomitant heparin with eptifibatide in acute coronary syndromes

Article

Mar 2001
AM J CARDIOL

Platelet glycoprotein IIb/IIIa inhibitors have been extensively studied in the treatment of patients with ischemic heart disease. Data regarding the use of these agents in the absence of concomitant intravenous heparin have been conflicting. We sought to determine, using propensity analysis, whether the benefit of eptifibatide, a IIb/IIIa inhibitor, in the treatment of acute coronary syndromes is affected by the concurrent administration of heparin. By trial design, patients were randomized to either eptifibatide or placebo, whereas use of intravenous heparin was left to the discretion of treating physicians. The effect of eptifibatide on the 30-day composite end point of death or myocardial infarction was studied in patients who received heparin and those who did not. Propensity analysis methods were used to control for confounding and presumed selection biases. Among 5,576 patients who were receiving heparin when the bolus dose of the study drug was administered, eptifibatide was associated with a reduced composite end point rate (13%) compared with that of placebo (14.5% vs 16.6%, p = 0.03). In contrast, among 1,441 patients who were not receiving heparin, there was no difference in 30-day event rates with eptifibatide compared with placebo (13.7% vs 13.1%, p >0.7). After a propensity score for use of heparin was developed, however, use of heparin did not affect the reduced risk associated with eptifibatide (adjusted relative risk [RR] for heparin-eptifibatide interaction term 0.90, 95% confidence interval [CI] 0.61 to 1.32, p >0.5), but the propensity for heparin use was a strong predictor of events (adjusted RR 1.76, 95% CI 1.42 to 2.17, p

An open-label preliminary trial of sertraline for treatment of major depression after acute myocardial infarction (the SADHAT Trial). Sertraline Anti-Depressant Heart Attack Trial

Article

Jun 1999
AM HEART J

Background: Depression occurs frequently in patients with acute myocardial infarction and is associated with increased mortality rates. It is not known whether serotonin reuptake inhibitors would be safe and effective for patients with depression after myocardial infarction and whether such treatment would reduce mortality rates. Methods and results: We conducted a multicenter, open-label, pilot study of sertraline treatment in patients with major depressive disorder identified 5 to 30 days after admission for acute myocardial infarction. Outcome measures included cardiovascular and hemostatic function, adverse events, and mood ratings. Twenty-six patients were enrolled in the study. During treatment there were no significant changes in heart rate, blood pressure, cardiac conduction, or left ventricular ejection fraction, and there was a trend toward reduced ventricular ectopic activity. There were no changes in coagulation measures. Bleeding time increased in 12 patients, decreased in 4 patients, and was unchanged in 2 patients. Three (12%) patients withdrew from treatment prematurely because of adverse events. Significant improvements in mood ratings occurred over the course of treatment. Conclusions: Sertraline treatment was associated with clinical improvement and was well tolerated in >85% of the patients in this open-label treatment trial for patients with major depression after myocardial infarction. These results encourage further controlled trials to establish the effects of treatment for this high-risk population.

Assessment Manual for Psychopharmacology. Revised, 1976

Article

Jan 1976

WA Guy

Heart Rate Variability

Article

Oct 2006
ANN NONINVAS ELECTRO

Marek Malik

The Task Force was established by the Board of the European Society of Cardiology and co-sponsored by the North American Society of Facing and Electrophysiology. It was organised jointly by the Working Groups on Arrhythmias arzd on Computers of Cardiology of the European Society of Cardiology. After exchanges of written views on the subject, the main meeting of a writing core of the Task Force took place on May 8-10. 1994, on Necker Island. Following external reviews, the tent of this report was approved by the Board of the European Society of Cardiology on August 19,1995, and by the Board of the North American Society of Facing and Electrophysiology on October 3, 1995.

Use of selective serotonin reuptake inhibitors and risk of developing first‐time acute myocardial infarction

Article

Aug 2001
BRIT J CLIN PHARMACO

Selective serotonin reuptake inhibitors (SSRIs) have been associated with serotonin depletion in platelets, potentially leading to abnormal aggregation and prolonged bleeding time. In view of the importance of serotonin in coronary thrombosis, and decreased platelet serotonin concentrations associated with SSRIs, the present study was performed to test the hypothesis of a decreased risk of acute myocardial infarction (AMI) associated with SSRIs. We conducted a population-based case-control analysis using the UK General Practice Research Database (GPRD). A total of 3319 patients aged 75 years or younger free of clinical conditions predisposing to ischaemic heart disease, with a first-time diagnosis of AMI between 1992 and 1997, and 13 139 controls without AMI matched to cases for age, sex, general practice attended, and calendar time were included. Conditional logistic regression was used to estimate relative risks. Adjusted odds ratios (with 95% CI) for current use of SSRIs, non-SSRIs, or other antidepressants, compared to the group of nonusers of antidepressants were 0.9 (95% CI 0.5,1.8), 0.9 (95% CI 0.7,1.2), and 1.3 (95% CI 0.6,2.8), respectively. As compared with nonuse of SSRIs, current use (regardless of any other antidepressants used) resulted in an adjusted OR of 1.1 (95% CI 0.7,1.6). The current analysis provides evidence that SSRI exposure does not substantially decrease the risk of developing first-time AMI in patients free of factors predisposing to ischaemic heart disease. However, due to relatively small numbers of exposed subjects and the resulting wide confidence intervals, further studies may be needed to document a lack of effect of SSRIs in subjects without pre-existing diseases predisposing to AMI.

Sertraline in prevention of depression

Article

Mar 1992

A group of 480 patients, aged 19-78 with an HRSD score of at least 17 and who met DSM-III criteria for major depressive disorder were studied. Patients were given placebo for a one-week single-blind run-in period, after which sertraline was administered for eight weeks. This was followed by 44 weeks in which patients received sertraline or placebo on a double-blind, randomised basis. Patients were assessed periodically using the 17-item HRSD and the Clinical Global Impression scales. During the entire double-blind period 24 (13.0%) sertraline patients relapsed compared with 48 (45.7%) placebo patients (P less than 0.001). The protective effect of sertraline was maintained throughout the 44 weeks. The study provides evidence that sertraline prevents relapse of the index episode of depression as well as recurrence of further episodes and has few side-effects.

Affective disorders and survival after acute myocardial infarction. Results from the post-infarction late potential study

Article

Oct 1991

Psychological data from 560 male survivors of acute myocardial infarction (AMI) were documented in the third week after onset of AMI. The psychodiagnostic assessment was designed to detect different forms of depression as well as hyperactive behaviour. A complete follow-up of these patients, which covers a period of 6 months, is available. Our findings indicate that affective disorders play an important role in the post-acute phase after AMI although the extent of myocardial infarction (as defined by an ECG score) and behaviour responses are not significantly related to one another. Different subforms of depression are not influenced by a history of angina pectoris, the degree and location of myocardial infarction, the occurrence of late potentials and age, whereas dyspnoea (P < 0·001) and the recurrence of myocardial infarction (P < 0·001) favour depressive mood states. Twelve cardiac deaths and 17 arrhythmic events occurred during the study period; they were significantly predicted by severe forms of post-AMI depression as revealed by univariate analysis. The evidence was stronger for predicting cardiac death (P < 0·001) than for arrhythmic events (P = < 0·035). The effect remains of borderline significance for cardiac death if all risk factors with a significant univariate influence are included in a multiple logistic regression model. The effect of depression is illustrated by Kaplan—Meier survival curves separated for patient groups with high as compared to low degrees of depression. Hyperactivity showed no impact on patient survival.

The nature and course of depression following myocardial infarction

Article

Sep 1989
ARCH INTERN MED

Two hundred eighty-three patients admitted to cardiac care units for myocardial infarction at two urban teaching hospitals were interviewed 8 to 10 days after infarction and 171 were reinterviewed 3 to 4 months later. Initially, 45% met diagnostic criteria for minor or major depression, including 18% with major depressive syndromes. Depression was not associated with the severity of cardiac illness but was associated with the presence of noncardiac medical illnesses. Three to 4 months after infarction, 33% of patients met criteria for minor or major depression. The large majority of patients who initially met criteria for major but not minor depression showed evidence of depression at 3 months and most patients with major depression had not returned to work by 3 months. Treatment of major depressive syndromes after myocardial infarction may reduce chronicity and disability, while minor depressive syndromes may be similar to normal grief and tend to be self-limited.

Major depressive diorder predicts cardiac events in patients with coronary artery disease

Article

Nov 1988

Fifty-two patients undergoing cardiac catheterization and subsequently found to have significant coronary artery disease (CAD) were given structured psychiatric interviews before catheterization. Nine of these patients met criteria for major depressive disorder. All 52 patients were contacted 12 months after catheterization, and the occurrence of myocardial infarction, angioplasty, coronary bypass surgery and death was determined. Results of the study show that major depressive disorder was the best predictor of these major cardiac events during the 12 months following catheterization. The predictive effect was independent of the severity of CAD, left ventricular ejection fraction, and the presence of smoking. Furthermore, with the exception of smoking, there were no statistically significant differences between those patients with major depressive disorder and the remaining patients on any variable studied. The possible mechanisms relating major depressive disorder to subsequent cardiac events are discussed. It is concluded that major depressive disorder is an important independent risk factor for the occurrence of major cardiac events in patients with CAD.

Depression Following Myocardial Infarction: A One Year Longitudinal Study

Article

Feb 1994

The purpose of this study was to examine the course and clinical correlates of depression during the first year after myocardial infarction. A group of seventy patients hospitalized for the treatment of myocardial infarction (MI) were assessed for the presence of mood disorders during their hospital admission and at three, six, nine, and twelve months follow-up. Patients were evaluated and diagnosed using the Present State Examination and DSM-III criteria. Impairment in activities of daily living was measured by the Johns Hopkins Functioning Inventory and impairment in social functioning was measured by the Social Functioning Examination. A total of twenty-four patients met DSM-III criteria for major depression at some time during the study (18 in the acute stage, 6 during follow-up). There were two patients with minor depression (dysthymia) at intake and six developed minor depression during the follow-up period. The median duration of major depression was 4.5 months. Patients with depression at intake had greater impairment in activities of daily living than non-depressed patients. Depressions lasting more than six months were more likely to be anxious depressions than those lasting less than six months. After the acute MI period, there was a consistent relationship between the existence of depression and impaired social functioning. This is a pilot study and needs further replication due to the low rate of follow-up participation. However, these data suggest that there may be two types of depression following MI: an acute depression associated with greater functional impairment, and a prolonged depression that may be associated with inadequate social support.

Depression following myocardial infarction. Impact on 6-month survival

Article

Nov 1993

To determine if the diagnosis of major depression in patients hospitalized following myocardial infarction (MI) would have an independent impact on cardiac mortality over the first 6 months after discharge. Prospective evaluation of the impact of depression assessed using a modified version of the National Institute of Mental Health Diagnostic Interview Schedule for major depressive episode. Cox proportional hazards regression was used to evaluate the independent impact of depression after control for significant clinical predictors in the data set. A large, university-affiliated hospital specializing in cardiac care, located in Montreal, Quebec. All consenting patients (N = 222) who met established criteria for MI between August 1991 and July 1992 and who survived to be discharged from the hospital. Patients were interviewed between 5 and 15 days following the MI and were followed up for 6 months. There were no age limits (range, 24 to 88 years; mean, 60 years). The sample was 78% male. Survival status at 6 months. By 6 months, 12 patients had died. All deaths were due to cardiac causes. Depression was a significant predictor of mortality (hazard ratio, 5.74; 95% confidence interval, 4.61 to 6.87; P = .0006). The impact of depression remained after control for left ventricular dysfunction (Killip class) and previous MI, the multivariate significant predictors of mortality in the data set (adjusted hazard ratio, 4.29; 95% confidence interval, 3.14 to 5.44; P = .013). Major depression in patients hospitalized following an MI is an independent risk factor for mortality at 6 months. Its impact is at least equivalent to that of left ventricular dysfunction (Killip class) and history of previous MI. Additional study is needed to determine whether treatment of depression can influence post-MI survival and to assess possible underlying mechanisms.

A placebo-controlled, randomized clinical trial comparing sertraline and imipramine for the treatment of dysthymia

Article

Oct 1996
ARCH GEN PSYCHIAT

Despite the high prevalence of dysthymia and its associated morbidity, few controlled trials have evaluated the efficacy of antidepressant medication for this disorder. A 12-week, double-blind, placebo-controlled, randomized, multicenter trial was performed to evaluate the safety and efficacy of sertraline hydrochloride and imipramine hydrochloride in treating dysthymia. A total of 416 outpatients (271 women and 145 men) aged 25 to 65 years with DSM-III-R-defined, early-onset, primary dysthymia without concurrent major depression were randomized to 12 weeks of treatment with sertraline, imipramine, or placebo. Both active treatments resulted in significantly reduced scores on the 17-item Hamilton Rating Scale for Depression (P = .04 and P = .01 for sertraline and imipramine vs placebo, respectively), the Montgomery-Asberg Depression Rating Scale (P = .01 and P = .003 vs placebo, respectively), Hopkins Symptom Checklist (P < .05), and the self-rated version of the Inventory of Depressive Symptoms (P < .05). With the use of a Clinical Global impressions improvement score of 1 or 2 (very much or much improved) to define response, response rates were 59% for sertraline, 64% for imipramine, and 44% for placebo (P = .02 for sertraline vs placebo and P < .001 for imipramine vs placebo). A significantly greater proportion of patients receiving imipramine than those receiving sertraline or placebo discontinued treatment because of adverse events (P = .001 and P < .001, respectively). Pharmacotherapy provides considerable relief from the symptoms of dysthymia in patients suffering from this chronic affective disorder, with both sertraline and imipramine being more effective than placebo. The greater tolerability of sertraline is an important consideration because of the chronicity of dysthymia, which may require prolonged treatment with antidepressant medication.

Major Depression Before and After Myocardial Infarction

Article

Mar 1996

The prevalence and prognostic impact of previous depression, depression in the hospital, and depression after discharge were studied in 222 patients admitted for acute myocardial infarction (MI). Patients were interviewed 1 week, 6 months, and 12 months after the index MI using a modified version of the Diagnostic Interview Schedule (DIS); patients also completed the Beck Depression Inventory (BDI). Patients or family members were recontacted at 18 months to determine survival. Some 27.5% of patients had at least one episode of major depression before their MI, but only 7.7% were depressed at some point during the year preceding the infarct. Overall, 31.5% of patients experienced depression in the hospital or during the year postdischarge. Some 35 patients were depressed in the hospital, 30 became depressed between discharge and 6 months, and five more between 6 and 12 months after the MI. History of depression increased the risk of depression in the hospital and after discharge. Depression in the hospital was associated with an increased risk of mortality over 18 months. Patients who experienced a recurrent depression in the hospital were at particularly high risk. Although patients who became depressed after discharge differed from those who remained depression-free in terms of age, history of depression, BDI scores, and the number of depression symptoms on the DIS in the hospital, a model including these variables identified only 14.7% of the patients who became depressed after returning home. Post-MI depression is common and largely unrelated to medical and psychosocial factors.

Prospective Validation of a Composite End Point in Thrombolytic Trials of Acute Myocardial Infarction (TIMI 4 and 5)

Article

Sep 1997
AM J CARDIOL

Although the use of composite end points in clinical trials has increased in recent years, few data are available on the validity of such an approach. In the Thrombolysis In Myocardial Infarction (TIMI) 4 and 5 trials, we set out to validate prospectively the nonfatal components of the "unsatisfactory outcome" end point. This end point consisted of the in-hospital occurrence or observation of new-onset severe congestive heart failure/shock, left ventricular ejection fraction <40% (or <30% for patients with prior myocardial infarction), reinfarction, reocclusion by sestamibi perfusion imaging, TIMI flow grade <2 at 90 minutes or 18 to 36 hours, intracranial hemorrhage, major spontaneous hemorrhage, or anaphylaxis. Among 576 patients in TIMI 4 and 5 with 1-year follow-up, a nonfatal unsatisfactory outcome end point was reached in hospital in 45% of patients. Compared with patients without such an end point, patients with an end point had a relative risk of 1-year mortality of 2.5 (95% confidence interval 1.4 to 5.6, p = 0.001). For individual components, new-onset severe congestive heart failure/shock had a relative risk of 4.6 (p = 0.001), left ventricular ejection fraction <40% had a relative risk of 3.5 (p = 0.006), recurrent myocardial infarction had a relative risk of 2.2 (p = 0.047), and TIMI flow grade <2 at 90 minutes had a relative risk of 2.2 (p = 0.005). Our findings show that these nonfatal in-hospital end points and the composite end point are associated with an increased risk of 1-year mortality and as such are valid predictive survival markers for use in clinical trials.

Depression and the Course of Coronary Artery Disease

Article

Feb 1998

Literature and folk wisdom have long linked depression and death; however, only recently have scientific studies examined the relation between them. Beginning in the 1970s, investigators compared mortality among patients treated for major depression and the general population. Nine of ten studies found an increased mortality from cardiovascular disease among depressed patients. However, such studies confound the relation between depression and its treatment. Community surveys circumvent this difficulty, but as these studies began to appear, other investigations revealed the strong association between depression and cigarette smoking, which made obvious a need to control for smoking. The first study to do this appeared in 1993, and not only did a relation between depression and mortality persist, but a relation between depression and the development of ischemic disease was revealed. In the past 2 years, six more community surveys have followed populations initially free of disease, and five have observed an increased risk of ischemic heart disease among depressed persons. Another research strategy is to start with subjects who have preexisting cardiovascular disease. Here, too, depression has consistently been associated with a worse outcome. In one well-designed study, patients with depression in the period immediately after a myocardial infarction were 3.5 times more likely to die than nondepressed patients. The basis of this association remains speculative. However, it is likely that the changes in the autonomic nervous system and platelets that are seen in depression account for a substantial portion of the association.

Excess Risk of Myocardial Infarction in Patients Treated with Antidepressant Medications: Association with Use of Tricyclic Agents

Article

Feb 2000
AM J MED

Several studies have found that depression and the use of antidepressant medications are associated with an increased risk of cardiovascular disease. We assessed the association between the use of antidepressant drugs and myocardial infarction, and whether that association differs between the tricyclic and selective serotonin reuptake inhibitor (SSRI) classes of medication. We compared the experience of a cohort of 2,247 working, union health plan members who received at least one prescription for an antidepressant in an accrual period of 1991-1992 with that of 52,750 members who did not. Patients were followed for up to 4.5 years (minimum 6 months). Three antidepressant medication classes were defined: tricyclics, SSRIs, and others. The primary outcome was hospitalization or death due to myocardial infarction. Adjusted for age and sex, antidepressant users had a relative risk of myocardial infarction of 2.2 (95% confidence interval [CI] 1.3 to 3.7) compared with nonusers of antidepressants. There were 16 myocardial infarctions among 1,650 users of tricyclic antidepressants, 2 among 655 SSRI users, and none among 279 users of other antidepressants. Adjusting for age, gender, baseline heart disease, diabetes, hypertension, hyperlipidemia, anxiety, and cancer, the relative risk of myocardial infarction was 2.2 (95% CI 1.2 to 3.8) in users of tricyclic agents and 0.8 (95% CI 0.2 to 3.5) in users of SSRIs, as compared with subjects who did not use antidepressants. The association between use of tricyclic antidepressants, but not SSRIs, with an increased risk of myocardial infarction in our patients suggests that an earlier report that there is no difference in risk between the antidepressant classes, based on short-term studies, may not apply to long-term adverse cardiovascular outcomes.

Treatment of Dysthymia With Sertraline: A Double-Blind, Placebo-Controlled Trial in Dysthymic Patients Without Major Depression

Article

Nov 2000

The selective serotonin reuptake inhibitor sertraline has been shown to be efficacious and well tolerated for the treatment of major depressive disorder. Relatively few trials, however, have examined the role of pharmacotherapy in dysthymia without concurrent major depression. The current investigation focuses on the use of sertraline for the treatment of dysthymia. In this 12-week, multicenter, double-blind study, 310 patients with a DSM-III-R diagnosis of dysthymic disorder without concurrent major depression were randomly assigned to receive either sertraline (N = 158) or placebo (N = 152). Sertraline was initiated at a dose of 50 mg daily, with titration permitted to a maximum of 200 mg daily. The primary evaluation criteria were the Structured Interview Guide for the Hamilton Depression Rating Scale, Seasonal Affective Disorder Version (SIGH-SAD), the Montgomery-Asberg Depression Rating Scale (MADRS), and the Clinical Global Impressions-Severity of Illness (CGI-S) and -Improvement (CGI-I) scales. Mean percentage reductions for the intent-to-treat population in SIGH-SAD scores were 44.6% for the sertraline-treated group and 33.2% for the placebo-treated group (p = .03); MADRS scores, 43.6% and 33.0% (p = .02); and CGI-S scores, 32.8% and 22.8% (p = .02). A significantly greater proportion of the sertraline-treated group was classified as responders (defined for HAM-D and MADRS scores as a 50% score reduction and for CGI-I as a score of 1 or 2 by the final visit) and remitters (SIGH-SAD score < or = 8) relative to the placebo-treated group by the final visit. In addition, sertraline-treated patients experienced greater improvements in all 9 domains of the Battelle Quality of Life Questionnaire than placebo-treated patients did, with a significant difference observed in favor of sertraline in 8 of the 9 domains. The life satisfaction and social interaction quality of life domains showed significantly greater response in sertraline responders compared with placebo SIGH-SAD responders. Sertraline was well tolerated. Thirteen percent of the sertraline-treated group versus 8% of the placebo-treated group withdrew from therapy owing to adverse events (p = .14). Sertraline is efficacious and well tolerated in the short-term treatment of dysthymia without concurrent major depression.

Depression after Myocardial Infarction

Article

Dec 1995
Cardiol Rev

Roy C Ziegelstein

Depression is an independent risk factor for increased postmyocardial infarction morbidity and mortality, even after controlling for the extent of coronary artery disease, infarct size, and the severity of left ventricular dysfunction. This risk factor takes on added significance when one considers that almost half of patients recovering from a myocardial infarction have major or minor depression and that major depression alone occurs in about one in five of these individuals. Despite the well-documented risk of depression, questions remain about the mechanism of the relationship between mood disturbance and adverse outcome. The link may be explained by an association with lower levels of social support, poor adherence to recommended medical therapy and lifestyle changes intended to reduce the risk of subsequent cardiac events, disturbances in autonomic tone, enhanced platelet activation and aggregation, and systemic immune activation. Unfortunately, questions about the pathophysiologic mechanism of depression in this setting are paralleled by uncertainties about the optimal treatment of depression for patients recovering from a myocardial infarction and by a lack of knowledge about whether treating depression lowers the associated increased mortality risk. Ongoing research studies will help to determine the benefits of psychosocial interventions and of antidepressant therapy for patients soon after myocardial infarction. Although the identification of depression as a risk factor may by itself be a reason to incorporate a comprehensive psychological evaluation into the routine care of patients with myocardial infarction, this practice should certainly become standard if studies show that treating depression reduces the increased mortality risk of these patients.

Howe HL, Wingo PA, Thun MJ, Ries LA, Rosenberg HM, Feigal EG, Edwards BKAnnual report to the nation on the status of cancer (1973 through 1998), featuring cancers with recent increasing trends. J Natl Cancer Inst 93: 824-842

Article

Jul 2001

The American Cancer Society, the National Cancer Institute (NCI), the North American Association of Central Cancer Registries, and the Centers for Disease Control and Prevention, including the National Center for Health Statistics (NCHS), collaborate to provide an annual update on cancer occurrence and trends in the United States. This year's report contains a special feature that focuses on cancers with recent increasing trends. From 1992 through 1998, age-adjusted rates and annual percent changes are calculated for cancer incidence and underlying cause of death with the use of NCI incidence and NCHS mortality data. Joinpoint analysis, a model of joined line segments, is used to examine long-term trends for the four most common cancers and for those cancers with recent increasing trends in incidence or mortality. Statistically significant findings are based on a P value of.05 by use of a two-sided test. State-specific incidence and death rates for 1994 through 1998 are reported for major cancers. From 1992 through 1998, total cancer death rates declined in males and females, while cancer incidence rates declined only in males. Incidence rates in females increased slightly, largely because of breast cancer increases that occurred in some older age groups, possibly as a result of increased early detection. Female lung cancer mortality, a major cause of death in women, continued to increase but more slowly than in earlier years. In addition, the incidence or mortality rate increased in 10 other sites, accounting for about 13% of total cancer incidence and mortality in the United States. Overall cancer incidence and death rates continued to decline in the United States. Future progress will require sustained improvements in cancer prevention, screening, and treatment.

De-pressionand18-monthprognosisaftermyocardialin-farction

999-1005

Frasure
N Smith
F Lesperance
Talajic

Frasure-Smith N, Lesperance F, Talajic M. De-pressionand18-monthprognosisaftermyocardialin-farction. Circulation. 1995;91:999-1005

forthe Thrombolysis in Myocardial Infarction Investigators Prospective validation of a composite end point in thrombolytictrialsofacutemyocardialinfarction(TIMI 4 and 5)

696-699

Cannoncp
Sharispj
Schweigermj

CannonCP,SharisPJ,SchweigerMJ,etal,forthe Thrombolysis in Myocardial Infarction Investigators. Prospective validation of a composite end point in thrombolytictrialsofacutemyocardialinfarction(TIMI 4 and 5). Am J Cardiol. 1997;80:696-699

Depressionisariskfactorforcoro-nary artery disease in men: the precursors study

1422-1426

Mead De La Ford
Chang
Cooper
L Patrick
Wangny

Ford DE, Mead LA, Chang PP, Cooper-Patrick L, WangNY,KlagMJ.Depressionisariskfactorforcoro-nary artery disease in men: the precursors study. Arch Intern Med. 1998;158:1422-1426

PsychometricpropertiesoftheBeckDe-pression Inventory: twenty-five years later

77-100

Beckat

BeckAT.PsychometricpropertiesoftheBeckDe-pression Inventory: twenty-five years later. Clin Psy-chol Rev. 1988;8:77-100

An-tidepressantefficacyofsertraline:adouble-blind,pla-cebo- and amitriptyline-controlled, multicenter com-parison study in outpatients with major depression

18-27

Fw Reimherr
G Chouinard
Cohn
Ck

Reimherr FW, Chouinard G, Cohn CK, et al. An-tidepressantefficacyofsertraline:adouble-blind,pla-cebo- and amitriptyline-controlled, multicenter com-parison study in outpatients with major depression. J Clin Psychiatry. 1990;51(suppl B):18-27

Depres-sioninpatientswithcoronaryheartdisease:a12-month follow-up

61-65

Hancem
Carneyrm
Freedlandke
Skalaj

HanceM,CarneyRM,FreedlandKE,SkalaJ.Depres-sioninpatientswithcoronaryheartdisease:a12-month follow-up. Gen Hosp Psychiatry. 1996;18:61-65

Symptoms of depression, acutemyocardialinfarction,andtotalmortalityinacom-munity sample

1976-1980

Jc Barefoot
Schroll

Barefoot JC, Schroll M. Symptoms of depression, acutemyocardialinfarction,andtotalmortalityinacom-munity sample. Circulation. 1996;93:1976-1980

A double-blind, placebo-controlled study comparing theeffectsofsertralineversusamitriptylineinthetreat-ment of major depression

484-491

Lydiardrb
Stahlsm
Hertzmanm

LydiardRB,StahlSM,HertzmanM,HarrisonWM. A double-blind, placebo-controlled study comparing theeffectsofsertralineversusamitriptylineinthetreat-ment of major depression. J Clin Psychiatry. 1997; 58:484-491

Association between depression and mor-talityinolderadults:theCardiovascularHealthStudy

1761-1768

Schulzr
Beachsr
Ivesdg
Martirelm
Ariyoaa
Kop

SchulzR,BeachSR,IvesDG,MartireLM,AriyoAA, Kop WJ. Association between depression and mor-talityinolderadults:theCardiovascularHealthStudy. Arch Intern Med. 2000;160:1761-1768

Mini-mentalstate”:apracticalmethodforgradingthecog-nitivestateofpatientsfortheclinician

189-198

Mf Folstein
Se Folstein
Mchugh

Folstein MF, Folstein SE, McHugh PR. “Mini-mentalstate”:apracticalmethodforgradingthecog-nitivestateofpatientsfortheclinician.JPsychiatrRes. 1975;12:189-198

Depressed affect,hopelessness,andtheriskofischemicheartdis-ease in a cohort of US adults

285-294

R Anda
Jones D D Williamson

Anda R, Williamson D, Jones D, et al. Depressed affect,hopelessness,andtheriskofischemicheartdis-ease in a cohort of US adults. Epidemiology. 1993;4: 285-294

Independentim-portanceofpsychosocialfactorsforprognosisaftermyo-cardial infarction

629-639

Welinc
Lappasg

WelinC,LappasG,WilhelmsenL.Independentim-portanceofpsychosocialfactorsforprognosisaftermyo-cardial infarction. J Intern Med. 2000;247:629-639

Life adjust-ment postmyocardial infarction

1680-1685

Mj Stern
L Pascale
A Ackerman

Stern MJ, Pascale L, Ackerman A. Life adjust-ment postmyocardial infarction. Arch Intern Med. 1977;137:1680-1685

Even minimalsymptomsofdepressionincreasemortalityrisk afteracutemyocardialinfarction

337-341

De Bush
Rc Ziegelstein
M Tayback

Bush DE, Ziegelstein RC, Tayback M, et al. Even minimalsymptomsofdepressionincreasemortalityrisk afteracutemyocardialinfarction.AmJCardiol.2001; 88:337-341

Areevaluationoftheexclusioncriteriausedinan-tidepressant efficacy trials

191-200

Ma Posternak
M Zimmerman
Gi Keitner
Miller

Posternak MA, Zimmerman M, Keitner GI, Miller IW.Areevaluationoftheexclusioncriteriausedinan-tidepressant efficacy trials. Am J Psychiatry. 2002; 159:191-200

2013 SADHART Data and Safety Monitoring Committee

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Downloaded From: http://jama.jamanetwork.com/ on 02/25/2013 SADHART Data and Safety Monitoring Committee: Marian Fisher, PhD, Stuart Connolly, MD, John M. Davis, MD, Sidney Goldstein, MD, Thomas Ryan, MD (Chair, DSMB).

Sertraline Treatment of Major Depression in Patients With Acute MI or Unstable Angina

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Sertraline Treatment of Major Depression in Patients With Acute MI or Unstable Angina