Treatment-Resistant Depression and Mortality After Acute Coronary Syndrome

Abstract

Depression is a risk factor for morbidity and mortality in patients with coronary heart disease (CHD), especially following acute coronary syndrome (ACS). Evidence from recent clinical trials suggests that treatment-resistant depression may be associated with a particularly high risk of mortality or cardiac morbidity in post-ACS patients. This manuscript reviews this evidence, and considers possible explanations for this relationship. Directions for future research are also considered, with particular emphasis on efforts to elucidate the underlying mechanisms and to develop more efficacious treatments for depression in patients with CHD.

The lack of association between components of metabolic syndrome and treatment resistance in depression

“…In line with the other studies (Carney and Freedland 2009;Sourey et al 2007) treatment resistance was present in approximately one third of our patients with MDD. Patients with TRD were older, had longer duration of disease, higher number of both depressive episodes and suicide attempts, as well as increased current suicidality, compared to non TRD patients.…”

“…Although TRD appears to be a common clinical condition, remarkably little is known about the underlying biology (Carney and Freedland 2009). Patients with TRD exhibit right superior, medio-frontal and striatal atrophy, as well as hippocampal and rostral anterior cingulate cortex changes, compared to non-TRD and healthy controls (Shah et al 2002).…”

Associação entre depressão, níveis de dor e falta de apoio social em pacientes internados em enfermarias de clínica médica

“…A média do número de parentes e amigos confidentes ± DP foi de 12, associam depressão com maior mortalidade utilizaram essa mesma escala, o BDI 11,12 ; 2) Nossa amostra foi composta por pacientes internados em um hospital universitário, com ní-vel de atenção terciário. É possível que pacientes na atenção primária ou secundária tenham padrões diferentes; 3) Por ser um estudo transversal, não é possível estabelecer relação de causa e efeito; 4) Pacientes muito graves e incapacitados (por exemplo, com dispneia intensa) foram excluídos por não conseguirem responder à entrevista, portanto não estão representados na nossa amostra.…”

“…Outra pesquisa evidenciou a associação entre a gravidade da depressão e a intensidade do pensamento catastrófico em pacientes com anemia falciforme 10 . Entre pacientes com dor coronariana aguda a depressão persistente vem sendo associada com aumento na mortalidade e na morbidade cardíaca 11 . Ou seja, apesar de repetidos estudos sobre o assunto, os mecanismos psicológicos e fisiológicos da dor e sua associação com depressão não estão esclarecidos e ainda são objeto de controvérsia.…”

Depression, Vascular Conditions and Chronicity

“…Although the high risk estimates may be inflated due to incomplete and biased reporting of adjustment, these meta-analytic data provide evidence for depression as a risk factor in the development and course of CVD. In addition, (Carney & Freedland, 2009) have reviewed the literature in order to identify subtypes of depression which are associated with the highest risk of cardiac events in coronary heart patients. They discuss existing evidence from several large clinical trials, such as ENRICHD, MIND-IT, and SADHART.…”