Depression and Comorbid Medical Illness

The interactions of personality traits, psychiatric symptoms and syndromes, and environmental stressors with the cardiovascular system have long intrigued investigators interested in the factors that contribute to the development and progression of atherosclerotic heart disease. Differences in rates of ischemic heart disease (IHD) remain substantially unexplained even after surveillance of the well-established risk factors. Although the type A personality pattern has been studied intensely as a risk factor for coronary artery disease (CAD), lack of a consistent association between type A behavior and the subsequent development of IHD has stimulated questions about the contributions of the psychological concept of hostility, as well as the syndrome of major depression. Increasing evidence is accumulating that suggests that major depression (Table 91–1),a mood disorder-is associated with drastically elevated morbidity and mortality after an index myocardial infarction (MI) and also acts as an independent risk factor in the development of atherosclerotic heart disease.

Depressive syndromes and major depression are exceedingly common. The most recent comprehensive study done in the United States, the National Comorbidity Study, reported lifetime prevalence rates of major depression (13 percent) and dysthymia (5 percent).

Point prevalence rates of major depression in primary care outpatients range from 2 to 16 percent and 9 to 20 percent for all depressive disorders and are even higher among medical inpatients: 8 percent for major depression and 15 to 36 percent for all depressive disorders.

Depression and Comorbid Medical Illness
Depression and Cardiovascular Disease: Clinical Samples
Pathophysiology
Anxiety Disorders and Cardiovascular Disease
Diminished Heart Rate Variability
Hypothalamic - Pituitary - Adrenocortical and Sympathomedullary Hyperactivity
Alterations in Platelet Receptors and/or Reactivity
Increased Secretion of Proinflammatory Cytokines
Pathophysiology of Anxiety
Treatment of Major Depression and Anxiety Disorders in Patients with Cardiovascular Disease
Effects of Mood and Anxiety Disorders: Future Directions for Research