Flashcards in Depression and Cardiovascular Disease Deck (11)
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1
Q
Associations between depression and averse outcomes in CVD
A
- depression increases risk of CAD by 1.5-2x in otherwise healthy individuals
- depression may account for 3% of DALYs due to ischemic heart disease
- 3% of general population is depressed vs. 20-30% of cardiac pts are depressed
- predicts mortality after acute coronary syndrome
- dose-response relationship: prognosis related to severity of depression
- predicts adverse outcomes among heart failure patients (mortality and rehospitalization)
- strongly associated w/poorer patient health status (e.g. symptoms burden, physical limitation,
2
Q
Major types of mechanisms for association of depression and CAD
A
- physiologic mechanisms
- behavioral barriers to optimal CV care
3
Q
Tx for depresson that improve outcomes for CV pts
A
- sertraline=SSRI –> used in pts w/ACS –> safe and improved depressive sx and quality of life
- telephone-delivered depression care
- collabortive care program = antidepressants + psychotherapy (IMPACT study)
4
Q
merits of depression screening in CV pts
A
- 75% of depressed ACS pts go unrecognized
- can screen with 2 simple questions, and further w/PHQ-9 (patient health questionnaire)
5
Q
Physiologic derangements in depression
A
- depressive symptoms –> high adrenergic state:
- autonomic dysfunction
- elevated cortisol
- platelet activation
- endothelial dysfunction
- inflammation
6
Q
Amygdala role in physiological regulation & depression
A
- perceives stress/fear –> mounts flight or fight response
- fxnl MRI shows hyperreactive amygdala in depressive patients
- constant fear –> high stress response
- hypothesis: defective serotonin signaling –> amygdala dysfxn –> autonomic dysfxn and hypercortisolemia
7
Q
Behavioral mechanisms linking depression and CVD
A
- depressed patients –> much less adherence to meds
- more likely to smoke
- much less physically active
- less likely to engage in health care system and follow-up
8
Q
Depression treatment impact on outcomes
A
- definitely improves: depression, quality of life, physiology
- not definitively known to improve: adherence, costs of care, CV events
9
Q
First line tx of depression in cardiac pts
A
- SSRIs = effective, safe, cost-effective
- buproprion (Wellbutrin) = anti-depressant + smoking cessation aid
- cognitive behavior therapy/problem solving therapy
- exercise training/cardiac rehabilitation
10
Q
Cardiac tx for depression considerations
A
- patient education about tx expectations
- structured follow-up
- dose/med adjustment
- mental health for complicated/refractory cases
11
Q
Summary of Depression in CVD
A
- depression is predictive of developing CVD
- depression is prevalent among and associated w/adverse outsomes in CV pts
- several mechanisms may explain these associations (biologic and behavioral)
- there are safe and effective screening and tx strategies
