Depression increases CVD risks


Risk of developing fatal MI 49% higher; lithium may decrease CV risk


Roughly one out of six women after menopause may have depression symptoms, which has been shown to be an independent predictor of cardiovascular (CV) mortality.

The risk of developing a fatal heart attack is also 49-percent higher if women have depression.

Dr. Seyyid Nassir Ghaemi, director at Mood Disorders Program, Department of Psychiatry, Tufts Medical Center, Boston, Massachusetts, stressed the importance of depression in post-menopausal women which can potentially lead to more serious complications.

National Health and Nutrition Examination Survey studied 5,000 patients with depression and cardiovascular disease (CVD). Results found 1.73 relative risks for women with depression compared to women without depression; and 1.71 relative risks for men, suggesting that men and women have similar 70-percent increase in risk of heart disease if they have depression. (Arch Intern Med. 2000;160[9]:1261-1268)

According to the Women’s Health Institute (WHI), 16 percent of the 93,676 population of the study had depression symptoms that were notable. It indicated the role of post-menopausal and depression to be an independent predictor of CV mortality.

Depression contributed to the increased risk of mortality even when patients controlled their hypertension, diabetes, cholesterol levels, with about 50-percent higher mortality. (Arch Intern Med. 2004;164[3]:289-298)

Depression and CVD treatment

The Myocardial Infarction and Depression Intervention Trial (MIND-IT), Sertraline Against Depression and Heart Disease (SADHART), and Enhancing Recovery in Coronary Heart Disease (ENRICHD) trials are some of the randomized controlled trials that highlight the influence of depression to other comorbodities.

ENRICHD studied 2,000 patients who have myocardial infarction (MI) and have high levels of depression. A >24 Hamilton Depressive Rating Scale (HDRS), shows a relatively severe, full blown, depressive episodes.

Patients of the study were also given serotonin reuptake inhibitors (SRIs) that showed no outcomes in the treatment. (JAMA 289, 3106-3116 2003)

SADHART observed patients who had heart failure (HF) who were randomized to sertraline (N=234) or placebo (N=235). But, sertraline compared with placebo, showed no difference in cardiovascular outcomes and no improvement of depression either.

Despite lack of positive outcomes, it was noted that sertraline was safe in patients with HF. (J Am Coll Cardiol. 2010; 56[9]:692-699).

Another study, MIND-IT, revealed that antidepressant treatment did not alter long-term depression post-MI nor improve cardiac prognosis. (Psychosom. Med. 69, 606-613 (2007)).

“Treating depression properly does affect CV. Although it doesn’t matter how the patients get better; it’s good, (whether it’s thru) medication, psychotherapy, or counseling,” Dr. Ghaemi said.

He cautioned that citalopram is not recommended as an antidepressant in patients with CVD because of its cardiac risks. The US Food and Drug Administration issued an advisory stressing that the dosing of citalopram should not be >40mg per day for it could be potentially arrhythmogenic. Dr. Ghaemi added that citalopram is associated with prolonged QTc interval.

Venlafaxine is widely used as antidepressant in the US, but restricted in UK for patients who do not have severe cardiac problems or severe hypertension because it increases the blood pressure (BP).

Dr. Ghaeimi reiterated that venlafaxine’s CV risks are well known and may not the best medication for patient with depression and heart disease.

“Fluoxetine is probably a safe medication for depression, but it has a lot of parameters to people with heart disease,” said Dr. Ghaemi. Fluoxetine has one of the lowest long-term rate of withdrawal syndrome.

Importance of lithium

In the Zurich study, lithium is associated with less dementia with an odd ratio of .23—77 percent decreased risk of dementia if the patients live longer—a fourfold decreased risk. (International Journal of Psychiatry in Clinical Practice, 2007, Vol. 11, No. 1, Pages 2-8)

Lithium

Lithium 1

Like many mineral that plays an important and basic bodily function in our body, deficiency in lithium can have consequences. Low in lithium results to low birth weight, impaired reproduction, and increased mortality.

In a systematic review of clinical, epidemiological, and biological reports on the clinical benefits of lithium by Drs. Ghaemi, Mauer, and Vergene, most studies on lithium in standard doses showed notable cognitive advantage or effectiveness in dementia prevention.

Five out of seven epidemiological studies found a link between standard-dose lithium and low dementia rates. Aside from dementia, lithium has also traces of biological benefits that influence suicide mortality rate and other behavioral outcomes. (ANZJP, 2014 48: 809-818)

Even though CVD is a common cause of death in people with bipolar, suicide tops the list of mortality in bipolar disorder and people with depression.

“There was a decrease in cardiovascular mortality if cases were treated for depression and bipolar as opposed to not being treated…there is some suggestive evidence that lithium may actually reduce cardiovascular mortality,” Dr. Ghaemi concluded. Ma. Vanessa L. Estinozo

June 2016 Health and Lifestyle

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