Depression Related Pathophysiologies Relevant in Heart Disease: Insights into the Mechanism Based on Pharmacological Treatments

Author(s): Treesa P. Varghese*, Anand V. Kumar, Nila M. Varghese, Sharad Chand

Journal Name: Current Cardiology Reviews

Volume 16 , Issue 2 , 2020

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Abstract:

Depressive symptoms are highly prevalent in patients with cardiac diseases. Co-morbid Depression in cardiac patients causes a significant reduction in health-related quality of life for the patients and inflicts an economic burden on the society. Two types of mechanisms that may explain the link between depression and cardiac diseases are the psychosocial and physiopathological mechanisms. Physiopathological mechanisms are direct biological mechanisms, which include hyperactivity of non-adrenergic and Hypothalamic Pituitary Adrenal Axis (HPA), abnormal platelet activation, endothelial dysfunction, and inflammatory process. Psychosocial factors include behavioral or lifestyle factors like smoking alcoholism and physical inactivity. Pharmacologic and therapeutic interventions are effective at reducing symptoms of depression in patients with cardiac disorders. Among pharmacological treatment, SSRIs seems to be effective for the reduction of depressive symptoms among patients with cardiac disorders because of their good efficacy and minimal cardiovascular side effects. Mechanisms of action of SSRI’s in depressive patients with cardiac disorders are associated with their ability to reduce inflammation, platelet, and endothelial dysfunction. This review focuses on the potential pathophysiological and psychosocial links between cardiac diseases and depression, the treatment options, and the importance of routine screening of depressive symptoms in cardiac settings.

Keywords: Depression, endothelial dysfunction, hypothalamic pituitary adrenal axis, inflammatory process, platelet activation, cardiac diseases.

[1]
Gan Y, Gong Y, Tong X, et al. Depression and the risk of coronary heart disease: a meta-analysis of prospective cohort studies. BMC Psychiatry 2014; 14: 371-82.
[http://dx.doi.org/10.1186/s12888-014-0371-z] [PMID: 25540022]
[2]
Varghese TP, Pannayapan L, Krishnakumar K, George L. A prospective study on the risk factors, angiographic severity and their correlation with STEMI and NSTEMI in patient with acute coronary symptoms. Harmoniz Res Med And Hlth Sci 2015; 2(1): 1-5.
[3]
Hare DL, Toukhsati SR, Johansson P, Jaarsma T. Depression and cardiovascular disease: a clinical review. Eur Heart J 2014; 35(21): 1365-72.
[http://dx.doi.org/10.1093/eurheartj/eht462] [PMID: 24282187]
[4]
Kachur S, Menezes AR, De Schutter A, Milani RV, Lavie CJ. Significance of comorbid psychological stress and depression on outcomes after cardiac rehabilitation. Am J Med 2016; 129(12): 1316-21.
[http://dx.doi.org/10.1016/j.amjmed.2016.07.006] [PMID: 27480388]
[5]
Seligman F, Nemeroff CB. The interface of depression and cardiovascular disease: therapeutic implications. Ann N Y Acad Sci 2015; 1345: 25-35.
[http://dx.doi.org/10.1111/nyas.12738] [PMID: 25809518]
[6]
Zhang Y, Chen Y, Ma L. Depression and cardiovascular disease in elderly: Current understanding. J Clin Neurosci 2018; 47: 1-5.
[http://dx.doi.org/10.1016/j.jocn.2017.09.022] [PMID: 29066229]
[7]
Rutledge T, Reis VA, Linke SE, Greenberg BH, Mills PJ. Depression in heart failure a meta-analytic review of prevalence, intervention effects, and associations with clinical outcomes. J Am Coll Cardiol 2006; 48(8): 1527-37.
[http://dx.doi.org/10.1016/j.jacc.2006.06.055] [PMID: 17045884]
[8]
Salem M, Hassan A, Elftoh AA, Kabil H, Elainen HA. Angiographic and clinical outcomes among patients with acute coronray syndromes presenting with isolated anterior ST- Segment Depression. Menoufia Med J 2015; 28(2): 597-01.
[http://dx.doi.org/10.4103/1110-2098.163925]
[9]
Moyer CF, Sajuthi D, Tulli H, Williams JK. Synthesis of IL-1 α and IL-1 β by arterial cells in atherosclerosis. Am J Pathol 1991; 138(4): 951-60.
[PMID: 2012178]
[10]
Ross R. Atherosclerosis--an inflammatory disease. N Engl J Med 1999; 340(2): 115-26.
[http://dx.doi.org/10.1056/NEJM199901143400207] [PMID: 9887164]
[11]
Hasper D, Hummel M, Kleber FX, Reindl I, Volk HD. Systemic inflammation in patients with heart failure. Eur Heart J 1998; 19(5): 761-5.
[http://dx.doi.org/10.1053/euhj.1997.0858] [PMID: 9717010]
[12]
Kania G, Blyszczuk P, Eriksson U. Mechanisms of cardiac fibrosis in inflammatory heart disease. Trends Cardiovasc Med 2009; 19(8): 247-52.
[http://dx.doi.org/10.1016/j.tcm.2010.02.005] [PMID: 20447565]
[13]
Heeschen C, Hamm CW, Bruemmer J, Simoons ML. Predictive value of C-reactive protein and troponin T in patients with unstable angina: a comparative analysis. CAPTURE Investigators. Chimeric c7E3 AntiPlatelet Therapy in Unstable angina REfractory to standard treatment trial. J Am Coll Cardiol 2000; 35(6): 1535-42.
[http://dx.doi.org/10.1016/S0735-1097(00)00581-7] [PMID: 10807457]
[14]
Howren MB, Lamkin DM, Suls J. Associations of depression with C-reactive protein, IL-1, and IL-6: a meta-analysis. Psychosom Med 2009; 71(2): 171-86.
[http://dx.doi.org/10.1097/PSY.0b013e3181907c1b] [PMID: 19188531]
[15]
Miller AH, Maletic V, Raison CL. Inflammation and its discontents: the role of cytokines in the pathophysiology of major depression. Biol Psychiatry 2009; 65(9): 732-41.
[http://dx.doi.org/10.1016/j.biopsych.2008.11.029] [PMID: 19150053]
[16]
Kop WJ, Kuhl EA, Barasch E, Jenny NS, Gottlieb SS, Gottdiener JS. Association between depressive symptoms and fibrosis markers: the Cardiovascular Health Study. Brain Behav Immun 2010; 24(2): 229-35.
[http://dx.doi.org/10.1016/j.bbi.2009.09.017] [PMID: 19800964]
[17]
Vaccarino V, Johnson BD, Sheps DS, et al. National Heart, Lung, and Blood Institute. Depression, inflammation, and incident cardiovascular disease in women with suspected coronary ischemia: the National Heart, Lung, and Blood Institute-sponsored WISE study. J Am Coll Cardiol 2007; 50(21): 2044-50.
[http://dx.doi.org/10.1016/j.jacc.2007.07.069] [PMID: 18021871]
[18]
Katafuchi T, Kondo T, Take S, Yoshimura M. Brain cytokines and the 5-HT system during poly I:C-induced fatigue. Ann N Y Acad Sci 2006; 1088: 230-7.
[http://dx.doi.org/10.1196/annals.1366.020] [PMID: 17192569]
[19]
Katafuchi T, Kondo T, Take S, Yoshimura M. Enhanced expression of brain interferon-α and serotonin transporter in immunologically induced fatigue in rats. Eur J Neurosci 2005; 22(11): 2817-26.
[http://dx.doi.org/10.1111/j.1460-9568.2005.04478.x] [PMID: 16324116]
[20]
Wirleitner B, Rudzite V, Neurauter G, et al. Immune activation and degradation of tryptophan in coronary heart disease. Eur J Clin Invest 2003; 33(7): 550-4.
[http://dx.doi.org/10.1046/j.1365-2362.2003.01186.x] [PMID: 12814390]
[21]
Skop BP, Brown TM. Potential vascular and bleeding complications of treatment with selective serotonin reuptake inhibitors. Psychosomatics 1996; 37(1): 12-6.
[http://dx.doi.org/10.1016/S0033-3182(96)71592-X] [PMID: 8600488]
[22]
Miyata K, Shimokawa H, Higo T, et al. Sarpogrelate, a selective 5-HT2A serotonergic receptor antagonist, inhibits serotonin-induced coronary artery spasm in a porcine model. J Cardiovasc Pharmacol 2000; 35(2): 294-301.
[http://dx.doi.org/10.1097/00005344-200002000-00018] [PMID: 10672864]
[23]
Verma S, Wang CH, Li SH, et al. A self-fulfilling prophecy: C-reactive protein attenuates nitric oxide production and inhibits angiogenesis. Circulation 2002; 106(8): 913-9.
[http://dx.doi.org/10.1161/01.CIR.0000029802.88087.5E] [PMID: 12186793]
[24]
Sherwood A, Hinderliter AL, Watkins LL, Waugh RA, Blumenthal JA. Impaired endothelial function in coronary heart disease patients with depressive symptomatology. J Am Coll Cardiol 2005; 46(4): 656-9.
[http://dx.doi.org/10.1016/j.jacc.2005.05.041] [PMID: 16098431]
[25]
Cooper DC, Milic MS, Tafur JR, et al. Adverse impact of mood on flow-mediated dilation. Psychosom Med 2010; 72(2): 122-7.
[http://dx.doi.org/10.1097/PSY.0b013e3181cdbfc0] [PMID: 20100885]
[26]
Tomfohr LM, Murphy MLM, Miller GE, Puterman E. Multiwave associations between depressive symptoms and endothelial function in adolescent and young adult females. Psychosom Med 2011; 73(6): 456-61.
[http://dx.doi.org/10.1097/PSY.0b013e3182228644] [PMID: 21715299]
[27]
Pizzi C, Manzoli L, Mancini S, Costa GM. Analysis of potential predictors of depression among coronary heart disease risk factors including heart rate variability, markers of inflammation, and endothelial function. Eur Heart J 2008; 29(9): 1110-7.
[http://dx.doi.org/10.1093/eurheartj/ehn137] [PMID: 18400765]
[28]
Vikenes K, Farstad M, Nordrehaug JE. Serotonin is associated with coronary artery disease and cardiac events. Circulation 1999; 100(5): 483-9.
[http://dx.doi.org/10.1161/01.CIR.100.5.483] [PMID: 10430761]
[29]
Arora RC, Meltzer HY. Increased serotonin2 (5-HT2) receptor binding as measured by 3H-lysergic acid diethylamide (3H-LSD) in the blood platelets of depressed patients. Life Sci 1989; 44(11): 725-34.
[http://dx.doi.org/10.1016/0024-3205(89)90384-6] [PMID: 2927243]
[30]
Nemeroff CB, Knight DL, Franks J, Craighead WE, Krishnan KRR. Further studies on platelet serotonin transporter binding in depression. Am J Psychiatry 1994; 151(11): 1623-5.
[http://dx.doi.org/10.1176/ajp.151.11.1623] [PMID: 7943450]
[31]
Kuijpers PMJC, Hamulyak K, Strik JJMH, Wellens HJJ, Honig A. β-thromboglobulin and platelet factor 4 levels in post-myocardial infarction patients with major depression. Psychiatry Res 2002; 109(2): 207-10.
[http://dx.doi.org/10.1016/S0165-1781(02)00017-3] [PMID: 11927146]
[32]
Serebruany VL, Suckow RF, Cooper TB, et al. Sertraline Antidepressant Heart Attack Randomized Trial. Relationship between release of platelet/endothelial biomarkers and plasma levels of sertraline and N-desmethylsertraline in acute coronary syndrome patients receiving SSRI treatment for depression. Am J Psychiatry 2005; 162(6): 1165-70.
[http://dx.doi.org/10.1176/appi.ajp.162.6.1165] [PMID: 15932816]
[33]
Anand IS, Fisher LD, Chiang YT, et al. Val-HeFT Investigators. Changes in brain natriuretic peptide and norepinephrine over time and mortality and morbidity in the Valsartan Heart Failure Trial (Val-HeFT). Circulation 2003; 107(9): 1278-83.
[http://dx.doi.org/10.1161/01.CIR.0000054164.99881.00] [PMID: 12628948]
[34]
Gold PW, Wong ML, Goldstein DS, et al. Cardiac implications of increased arterial entry and reversible 24-h central and peripheral norepinephrine levels in melancholia. Proc Natl Acad Sci USA 2005; 102(23): 8303-8.
[http://dx.doi.org/10.1073/pnas.0503069102] [PMID: 15919819]
[35]
Frenneaux MP. Autonomic changes in patients with heart failure and in post-myocardial infarction patients. Heart 2004; 90(11): 1248-55.
[http://dx.doi.org/10.1136/hrt.2003.026146] [PMID: 15486114]
[36]
Buccelletti E, Gilardi E, Scaini E, et al. Heart rate variability and myocardial infarction: systematic literature review and metanalysis. Eur Rev Med Pharmacol Sci 2009; 13(4): 299-307.
[PMID: 19694345]
[37]
Bauer LK, Caro MA, Beach SR, et al. Effects of depression and anxiety improvement on adherence to medication and health behaviors in recently hospitalized cardiac patients. Am J Cardiol 2012; 109(9): 1266-71.
[http://dx.doi.org/10.1016/j.amjcard.2011.12.017] [PMID: 22325974]
[38]
Palur Ramakrishnan AV, Varghese TP, Vanapalli S, Nair NK, Mingate MD. Platelet activating factor: A potential biomarker in acute coronary syndrome? Cardiovasc Ther 2017; 35(1): 64-70.
[http://dx.doi.org/10.1111/1755-5922.12233] [PMID: 27790832]
[39]
Hekler EB, Rubenstein J, Coups EJ, Gilligan S, Kusnecov AW. Inflammatory markers in acute myocardial infarctionpatients: Preliminary evidence of a prospective association with depressive symptoms. J Appl Biobehav Res 2007; 12: 65-81.
[http://dx.doi.org/10.1111/j.1751-9861.2007.00014.x]
[40]
Frasure-Smith N, Lespérance F, Irwin MR, Sauvé C, Lespérance J, Théroux P. Depression, C-reactive protein and two-year major adverse cardiac events in men after acute coronary syndromes. Biol Psychiatry 2007; 62(4): 302-8.
[http://dx.doi.org/10.1016/j.biopsych.2006.09.029] [PMID: 17210140]
[41]
Shimbo D, Rieckmann N, Paulino R, Davidson KW. Relation between C reactive protein and depression remission status in patients presenting with acute coronary syndrome. Heart 2006; 92(9): 1316-8.
[http://dx.doi.org/10.1136/hrt.2005.075861] [PMID: 16908705]
[42]
Drago S, Bergerone S, Anselmino M, et al. Depression in patients with acute myocardial infarction: influence on autonomic nervous system and prognostic role. Results of a five-year follow-up study. Int J Cardiol 2007; 115(1): 46-51.
[http://dx.doi.org/10.1016/j.ijcard.2006.04.029] [PMID: 16797746]
[43]
Carney RM, Saunders RD, Freedland KE, Stein P, Rich MW, Jaffe AS. Association of depression with reduced heart rate variability in coronary artery disease. Am J Cardiol 1995; 76(8): 562-4.
[http://dx.doi.org/10.1016/S0002-9149(99)80155-6] [PMID: 7677077]
[44]
Laghrissi-Thode F, Wagner WR, Pollock BG, Johnson PC, Finkel MS. Elevated platelet factor 4 and beta-thromboglobulin plasma levels in depressed patients with ischemic heart disease. Biol Psychiatry 1997; 42(4): 290-5.
[http://dx.doi.org/10.1016/S0006-3223(96)00345-9] [PMID: 9270907]
[45]
May HT, Sheng X, Catinella AP, Horne BD, Carlquist JF, Joy E. Antilipidemic adherence post-coronary artery disease diagnosis among those with and without an ICD-9 diagnosis of depression. J Psychosom Res 2010; 69(2): 169-74.
[http://dx.doi.org/10.1016/j.jpsychores.2010.01.026] [PMID: 20624515]
[46]
Scholz U, Knoll N, Sniehotta FF, Schwarzer R. Physical activity and depressive symptoms in cardiac rehabilitation: long-term effects of a self-management intervention. Soc Sci Med 2006; 62(12): 3109-20.
[http://dx.doi.org/10.1016/j.socscimed.2005.11.035] [PMID: 16388882]
[47]
Hillhouse TM, Porter JH. A brief history of the development of antidepressant drugs: from monoamines to glutamate. Exp Clin Psychopharmacol 2015; 23(1): 1-21.
[http://dx.doi.org/10.1037/a0038550] [PMID: 25643025]
[48]
Church MK, Church DS. Pharmacology of antihistamines. Indian J Dermatol 2013; 58(3): 219-24.
[http://dx.doi.org/10.4103/0019-5154.110832] [PMID: 23723474]
[49]
Yekehtaz H, Farokhnia M, Akhondzadeh S. Cardiovascular considerations in antidepressant therapy: an evidence-based review. J Tehran Heart Cent 2013; 8(4): 169-76.
[PMID: 26005484]
[50]
Glassman AH, Bigger JT Jr. Cardiovascular effects of therapeutic doses of tricyclic antidepressants. A review. Arch Gen Psychiatry 1981; 38(7): 815-20.
[http://dx.doi.org/10.1001/archpsyc.1981.01780320095011] [PMID: 7247643]
[51]
Gillman PK. Tricyclic antidepressant pharmacology and therapeutic drug interactions updated. Br J Pharmacol 2007; 151(6): 737-48.
[http://dx.doi.org/10.1038/sj.bjp.0707253] [PMID: 17471183]
[52]
Wang JT, Hoffman B, Blumenthal JA. Management of depression in patients with coronary heart disease: association, mechanisms, and treatment implications for depressed cardiac patients. Expert Opin Pharmacother 2011; 12(1): 85-98.
[http://dx.doi.org/10.1517/14656566.2010.513701] [PMID: 20715885]
[53]
Ernstsen L, Rangul V, Nauman J, et al. Protective effect of regular physical activity on depression after myocardial infarction: The HUNT study. Am J Med 2016.
[http://dx.doi.org/10.1016/j.amjmed.2015.08.012]
[54]
Lavie CJ, Menezes AR, De Schutter A, Milani RV, Blumenthal JA. Impact of cardiac rehabilitation and exercise training on psychological risk factors and subsequent prognosis in patients with cardiovascular disease. Can J Cardiol 2016; 32(10)(Suppl. 2): S365-73.
[http://dx.doi.org/10.1016/j.cjca.2016.07.508] [PMID: 27692117]
[55]
Milani RV, Lavie CJ. Impact of cardiac rehabilitation on depression and its associated mortality. Am J Med 2007; 120(9): 799-806.
[http://dx.doi.org/10.1016/j.amjmed.2007.03.026] [PMID: 17765050]
[56]
Moise N, Thanataveerat A, Florez-Salamanca L, et al. Willingness to engage in traditional and novel depression treatment modalities among myocardial infarction survivors. J Gen Intern Med 2019.
[http://dx.doi.org/10.1007/s11606-019-05406-8] [PMID: 31659671]


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VOLUME: 16
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Year: 2020
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DOI: 10.2174/1573403X15666191127104520
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