Mania and mortality: Why the excess cardiovascular risk in bipolar disorder?

Murray, D.; Weiner, Miriam; Prabhakar, Maithri; Fiedorowicz, Jess G.

doi:10.1007/s11920-009-0072-3

Cited by 65 publications

(48 citation statements)

References 58 publications

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“…3,4,73,74 Although other processes have also been examined, the sections below highlight inflammation, oxidative stress, and autonomic dysfunction in particular because these arguably have the strongest data thus far.…”

Section: Pathophysiological Processes Bridgingmentioning

confidence: 99%

Major Depressive Disorder and Bipolar Disorder Predispose Youth to Accelerated Atherosclerosis and Early Cardiovascular Disease

Goldstein¹,

Carnethon²,

Matthews³

et al. 2015

Circulation

414

290

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Abstract-In the 2011 "Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children andAdolescents," several medical conditions among youth were identified that predispose to accelerated atherosclerosis and early cardiovascular disease (CVD), and risk stratification and management strategies for youth with these conditions were elaborated. Major depressive disorder (MDD) and bipolar disorder (BD) among youth satisfy the criteria set for, and therefore merit inclusion among, Expert Panel tier II moderate-risk conditions. The combined prevalence of MDD and BD among adolescents in the United States is ≈10%, at least 10 times greater than the prevalence of the existing moderate-risk conditions combined. The high prevalence of MDD and BD underscores the importance of positioning these diseases alongside other pediatric diseases previously identified as moderate risk for CVD. The overall objective of this statement is to increase awareness and recognition of MDD and BD among youth as moderate-risk conditions for early CVD. To achieve this objective, the primary specific aims of this statement are to (1) summarize evidence that MDD and BD are tier II moderate-risk conditions associated with accelerated atherosclerosis and early CVD and (2)

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Section: Pathophysiological Processes Bridgingmentioning

confidence: 99%

Major Depressive Disorder and Bipolar Disorder Predispose Youth to Accelerated Atherosclerosis and Early Cardiovascular Disease

Goldstein¹,

Carnethon²,

Matthews³

et al. 2015

Circulation

414

290

View full text Add to dashboard Cite

show abstract

“…A larger association for bipolar disorder was observed in a similarly designed Swedish study, wherein a SMR of 1.6 was again seen for unipolar major depression though in bipolar disorder this estimate reached 2.2 [6]. The majority of studies that assessed the SMR for both mood diagnoses have found a greater burden of cardiovascular mortality in bipolar disorder compared to unipolar major depression [7]. …”

Section: Vascular Morbidity and Mortality In Mood Disordersmentioning

confidence: 99%

Depression and Cardiovascular Disease: An Update on How Course of Illness May Influence Risk

Fiedorowicz

2014

Curr Psychiatry Rep

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Depression constitutes a novel and independent risk factor for cardiovascular disease, which despite extensive support in the literature has been underappreciated. While much of the evidence for depression as a risk factor for cardiovascular disease is based on studies following myocardial infarction, the elevated vascular risk conveyed by depression is not confined to periods following acute coronary syndromes. For that matter, the risk appears across mood disorders with evidence for even greater risk in bipolar disorder. This review summarizes the literature linking depressive disorders to cardiovascular mortality with a focus on how the course of illness of mood disorders may influence this risk. Mood disorders may influence risk over decades of illness in a dose-response to symptom burden, or the persistence of affective symptomatology. This may be mediated through changes in the activity of the autonomic nervous system, the hypothalamic-pituitary-adrenal axis, and inflammatory cytokines. Whether treatment of depression can mitigate this risk is not established although there are suggestions to support this contention, which could be better studied with more effective treatments of depression and larger standardized samples. Directions for future study of mechanisms and treatment are discussed. Regardless of causal mechanisms, persons with depressive disorders and other risk factors for vascular disease represent a neglected, high-risk group for cardiovascular events. In addition to the appropriate treatment for depression, screening and optimized management of traditional risk factors for cardiovascular diseases is necessary.

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“…However, despite these concerns, antidepressants are frequently employed by physicians that face the complex problems of dealing with bipolar depression (Haeberle et al 2012;Sussman et al 2012). Metabolic abnormalities are common in patients with BD, with a relative risk for metabolic syndrome (MetS) and type 2 diabetes of 1.6-2 in patients with BD compared with the general population (Murray et al 2009;Vancampfort et al 2013Vancampfort et al , 2015a. Patients with BD, especially during depressive phases, are inactive, often eat unhealthy food, smoke more cigarettes (Bly et al 2014;Fagiolini et al 2008;Vancampfort et al 2015b), do not take care of themselves, and do not attend medical checkups (Bradford et al 2008), by all these reasons increasing the risk for metabolic and eventually cardiovascular disease.…”

Section: Introductionmentioning

confidence: 99%

High H1-affinity antidepressants and risk of metabolic syndrome in bipolar disorder

et al. 2015

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RationaleMetabolic syndrome (MetS) is common in patients with bipolar disorder, with a relative risk of 1.6-2 compared to the general population. The increased risk is believed to be due to unhealthy lifestyles and use of medications. Although antipsychotics and mood stabilizers have been associated with weight gain and MetS, the impact of antidepressants has not been comprehensively evaluated. ObjectiveThe objective of the study is to assess the risk of MetS in patients exposed to different types of antidepressants. MethodsIn this cross-sectional study, 294 patients with bipolar disorder were consecutively recruited. MetS was diagnosed according to NCEP ATP-III modified criteria. Antidepressants used by the patients were classified according to the usual nomenclature (SSRI, TCA, SNRI, and other antidepressants) and a pharmacodynamic classification taking into account histamine 1-receptor (H1-R) affinity. ResultsUse of antidepressants in general was not associated with MetS (prevalence ratio [PR], 1.08; 95% confidence interval, 0.73 to 1.62; p = 0.70). However, subjects using H1-R high-affinity antidepressants (N = 15) showed a substantial increase in the prevalence of MetS (PR, 2.17; 95 % confidence interval, 1.24 to 3.80; p = 0.007). When we included the inhibition constant (Ki) as a continuous covariate in the models, we found an inverse association between Ki and prevalence of MetS (p = 0.004). ConclusionWe observed for the first time in a clinical setting that a pharmacodynamic-based classification of antidepressants could be more useful than the traditional one to predict the risk of MetS in patients with bipolar disorder. Clinical consequences may be relevant. However larger studies are warranted to generalize these results.

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Mania and mortality: Why the excess cardiovascular risk in bipolar disorder?

Cited by 65 publications

References 58 publications

Major Depressive Disorder and Bipolar Disorder Predispose Youth to Accelerated Atherosclerosis and Early Cardiovascular Disease

Major Depressive Disorder and Bipolar Disorder Predispose Youth to Accelerated Atherosclerosis and Early Cardiovascular Disease

Depression and Cardiovascular Disease: An Update on How Course of Illness May Influence Risk

High H1-affinity antidepressants and risk of metabolic syndrome in bipolar disorder

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