Volume 5 Issue 3 Mar 2015
Consultation- Liaison Psychiatry Focus: Cardiology
Depression affects about 20% of people with coronary artery disease & is linked to poor medical outcome. Depression is three times more common in cardiac-patients than in the general population. The prevalence of depression is higher in women than in men. Depression in healthy people increases their risk of subsequently developing coronary artery disease (CAD) by 60%.
Depression may be a contributing factor to the development or progression of CAD, or may be secondary to the presence of CAD, or common mechanisms may result in the development of both depression & CAD. Several pathophysiologic mechanisms have been proposed for the association of CAD & Depression:
- Overactivity of the hypothalamic-pituitary-adrenal axis & the sympathorenal system;
- Reduced parasympathetic flow and decreased heart rate variability;
- Endothelial dysfunctions
- Enhanced platelet activity
- Increased inflammations
Common symptoms of depression are depressed mood, lack of pleasure, functional impairment, feelings of hopelessness, worthlessness, wish to die, suicidal ideas (in some cases with severe depression), decreased appetite and sleep, etc.
Management of depression in CAD patients is multipronged. Psychological interventions such as individual or group-counselling, stress-management, mindfulness based stress reduction, cognitive-behavioral-therapy, support for self-care, & pharmacotherapy are likely to benefit. Antidepressants useful in cardiac patients include SSRIs (sertraline, escitalopram, fluoxetine, fluvoxamine), mirtazapine, & bupropion. Venlafaxine is generally avoided as it needs careful monitoring of blood pressure. Tricyclic-antidepressants should be avoided as first-line therapy due to their cardiotoxic-potential.
A healthy lifestyle especially physical activity tailored to patients’ functional-capabilities is always recommended to decrease depression and to improve well-being.
DR. BARUN KUMAR, DM Cardiology. Assistant Professor, Department of Medicine (Cardiology), Shri Mahant Indiresh Hospital (SMIH) and Shri Guru Ram Rai Institute of Medical & Health Sciences (SGRRIMHS), Dehradun, Uttarakhand-248001. Email: drbarun79@gmail.com.
