Treatment of depression in patients with congestive heart failure

Abstract

Heart failure is common, and depression is common in heart failure patients, adding substantially to the burden of the disease. There is some evidence for the safe and at least modestly effective use of psychotherapy and antidepressants to treat depression in heart failure patients. Cognitive behavioral psychotherapy and selective serotonin reuptake inhibitors are first line treatments. The efficacy of depression treatment in altering cardiac outcomes in heart failure patients has yet to be established.

Depression After Myocardial Infarction

“…The appearance of fluoxetine in the 1980s was quickly followed by a number of competing medications within the same class that all were marketed with reasonable cardiac tolerance [30,31]. The primary mechanism of action of SSRIs results in increased serotonin circulation by blocking presynaptic serotonin receptors.…”

“…The primary mechanism of action of SSRIs results in increased serotonin circulation by blocking presynaptic serotonin receptors. This results in a downregulation of the actual receptors, sustaining the level of circulating serotonin [30,32]. This effect has been shown to improve mood in patients with depression, decreasing the prevalence of clinical depression.…”

Clinical Trial Evidence for Treatment of Depression in Heart Failure

“…The appearance of fluoxetine in the 1980s was quickly followed by several competing medications within the same class that were all marketed with reasonable cardiac tolerance. 7 The primary mechanism of action of selective serotonin reuptake inhibitors (SSRIs) results in increased serotonin circulation by blocking presynaptic serotonin receptors. This results in a down-regulation of the actual receptors, sustaining the level of circulating of serotonin.…”

“…This results in a down-regulation of the actual receptors, sustaining the level of circulating of serotonin. 7,8 This effect has been shown to improve the mood in depressed patients, decreasing the prevalence of clinical depression. Although there is an acceptance of cardiac tolerance for this drug class, there are also some varying degrees of anticholinergic effects, sedation, and weight gain for different SSRIs.…”

“…7 Realistically, this is most likely a conservative estimation of prevalence in the overall clinical practice environment. Although the motivation to understand the impact of depression in CVD has focused on various specific populations in acute or subacute phases of CVD, the chronic heart failure patient population has become a much more emphasized group for evaluation over the past decade.…”