Komorbidität zwischen kardiovaskulären Erkrankungen und Depressionen

Zusammenfassung

Etwa 20-25 % aller Patienten mit Herz-Kreislauf-Erkrankungen leiden gleichzeitig an Depressionen. Depressive Erkrankungen erhöhen das kardiovaskuläre Morbiditäts- und Mortalitätsrisiko. Vieles spricht für eine multikausale Interaktion zwischen depressiven und kardiovaskulären Erkrankungen; neben genetischen Faktoren werden endokrine, neurokardiologische, metabolische und behaviorale Faktoren diskutiert. Obwohl Depressionen überzufällig häufig ältere und multimorbide Patienten betreffen, werden sie in der klinischen Praxis nur bei etwa der Hälfte dieser Patienten korrekt diagnostiziert, und selbst im Falle einer korrekten Diagnose zumeist nur unzureichend behandelt. Die meisten dieser Patienten werden primär nicht von Psychiatern, sondern von Ärzten anderer Fachrichtungen betreut. In Anbetracht der signifikanten Interaktion zwischen depressiven und kardiovaskulären Erkrankungen ist eine engmaschige Vernetzung aller am Behandlungsprozess beteiligten Arztgruppen nicht zuletzt auch aus ökonomischen Gründen zur Vermeidung von Folgekosten zwingend notwendig.

Summary

Some 20-25 % of all patients with cardiovascular diseases simultaneously suffer from depression. Depressive diseases increase the cardiovascular morbidity and mortality risk. There is much evidence for a multicausal interaction between depressive and cardiovascular diseases; apart from genetic factors, endocrine, neurocardiological, metabolic and behavioural factors are under discussion. Although depression is found disproportionately often in the elderly and multimorbid patient, it is correctly diagnosed in only about one-half of these patients, and even when correctly diagnosed, is usually inadequately treated. Most of these patients are under the care not of psychiatrists, but other specialists. In light of the significant interaction between depressive and cardiovascular diseases, close cooperation of all the physicians involved in the management process is urgently mandated, not least for economic reasons to avoid follow-up costs.

Key Words:

depression - cardiovascular disease - affective illness

Literatur

• 1 Agelink MW, Boz C, Ullrich H, Andrich J. Relationship between major depression and heart rate variability: clinical consequences and implications for antidepressive treatment.  Psychiatry Res. 2002;  113 139-149
• 2 Agelink MW, Majewski T, Wurthmann C. et al. . Autonomic neurocardiac function in patients with major depression and effects of antidepressive treatment with nefazodone.  J Affect Dis. 2001;  62 187-198
• 3 Anda R, Williamson D, Jones D. et al. . Depressed affect, hopelessness, and the risk of ischemic heart disease in a cohort of US adults.  Epidemiology. 1993;  4 285-294
• 4 Barefoot JC, Schroll M. Symptoms of depression, acute myocardial infarction, and total mortality in a community sample.  Circulation. 1996;  93 1976-1980
• 5 Ben-David J, Zipes DP. Autonomic neural modulation of cardiac rhythm: Part I. Basic concepts.  Modern Concepts of Cardiovascular Disease. 1988;  57 41-46
• 6 Blumenthal JA, Williams RS, Wallace AG, Williams RB, Needles TL. Physiological and psychological variables predict compliance to prescribed exercise therapy in patients recovering from myocardial infarction.  Psychosom Med. 1982;  44 519-527
• 7 Bondy B, Baghai TC, Zill P. et al. . Combined action of the ACE D- and the G-protein beta-3-T-allele in major depression: a possible link to cardiovascular disease?.  Mol Psychiatry. 2002;  7 1120-1126
• 8 Carney RM, Rich MW, teVelde A, Saini J, Clark K, Jaffe AS. Major depressive disorder in coronary artery disease.  Am J Cardiol. 1987;  60 1273-1275
• 9 Comings DE, McMurray JP, Gonzales N, Ferry L, Peters WR. Association of the serotonin transporter gene with serum cholesterol levels and heart disease.  Mol Genet Metab. 1999;  67 248-253
• 10 Coryell W, Turvey C, Leon A. et al. . Persistance of depressive symptoms and cardio-vascular death among patients with affective disorder.  Psychosom Med. 1999;  61 755-761
• 11 Davidson K, Jonas BS, Dixon E, Markowitz JH. Do depression symptoms predict early hypertension - incidence in young adults in the CARDIA study.  Arch Intern Med. 2000;  160 1495-1500
• 12 Everson SA, Goldberg DE, Kaplan GA, Cohen RD, Pukkala E, Tuomilehto J, Salonen JT. Hopelessness and risk of mortality and incidence of myocardiale infarction and cancer.  Psychosom Med. 1996;  58 113-121
• 13 Ferketich AK, Schwartzbaum JA, Frid DJ, Moeschberger ML. Depression as an antecedent to heart disease among women and men in the NHANES I study.  Arch Intern Med. 2000;  160 1261-1268
• 14 Ford DE, Mead LA, Chang PP, Cooper-Patrick L, Wang NY, Klag MJ. Depression is a risk factor for coronary artery disease in men.  Arch Intern Med. 1998;  158 1422-1426
• 15 Frasure-Smith N, Lesperance F, Talajic M. Depression and 18-month prognosis after myocardial infarction.  Circulation. 1995;  91 999-1005
• 16 Frasure-Smith N, Lesperance F, Talajic M. Depression following myocardial infarction: impact on 6-month survival.  JAMA. 1993;  270 1819-1861
• 17 Glassman AH, Shapiro PA. Depression and the course of coronary artery disease.  Am J Psychiatr. 1998;  155 4-11
• 18 Goldberg EL, Comstock GW, Hornstra RK. Depressed mood and subsequent physical illness.  Am J Psychiatr. 1979;  136 530-534
• 19 Hayward C. Psychiatric illness and cardiovascular disease risk.  Epidemiol Rev. 1995;  17 129-138
• 20 Herrmann C, Brand-Driehorts S, Buss U, Rüger U. Effects of anxiety and depression on 5-year mortality in 5057 patients referred for exercise testing.  J Psychosom Res. 2000;  48 455-462
• 21 Heßlinger B, Härter M, Barth J. et al. . Komorbidität von depressiven Störungen und kardiovaskulären Erkrankungen.  Nervenarzt. 2002;  73 205-218
• 22 Jiang W, Babyak M, Krantz DS. et al. . Mental stress-induced myocardial ischemia and cardiac events.  JAMA. 1996;  275 1651-1656
• 23 Kannel WB, Kannel C, Paffenbarger RS, Cupples LA. Heart rate and cardiovascular mortality: The Framingham Study.  Am Heart J. 1987;  113 1489-1494
• 24 Kittayaphong R, Cascio WE, Light KC. et al. . Heart rate variability in patients with coronary artery disease: Differences in patients with higher and lower depression scores.  Psychosom Med. 1997;  59 231-235
• 25 Lake CR, Pickar D, Ziegler MG, Lipper S, Slater S, Murphy DL. High plasma norepinephrine levels in patients with major affective disorder.  Am J Psychiatry. 1982;  139 1315-1318
• 26 Lederbogen F, Gilles M, Maras A. et al. . Increased platelet aggregability in major depression.  Psychiatry Res. 2001;  102 255-261
• 27 Lesperance F, Frasure-Smith N, Juneau M, Theroux P. Depression and 1-year prognosis in unstable angina.  Arch Intern Med. 2000;  160 1354-1360
• 28 Light KC, Kothandapani RV, Allen MT. Enhanced cardiovascular and catecholamine responses in women with depressive symptoms.  Int J Psychophysiol. 1998;  28 157-166
• 29 Linden M, Kurtz G, Baltes MM. et al. . Depression in the very elderly.  Nervenarzt. 1998;  69 27-37
• 30 Lown B, Verrier RL, Rabinowitz SH. Neural and psychologic mechanisms and the problem of sudden cardiac death.  Am J Cardiol. 1977;  39 890-902
• 31 Lown B, Verrier RL. Neural activity and ventricular fibrillation.  N Engl J Med. 1976;  294 1165-1170
• 32 Maes M, Smith R, Christophe A. et al. . Lower serum high-density lipoprotein cholesterol (HDL) in major depression and in depressed men with serious suicidal attempts: relationship with immune-inflammatory markers.  Acta Psychiatr Scand. 1997;  95 212-221
• 33 Malzberg B. Mortality among patients with in involution melancholia.  Am J Psychiatr. 1937;  93 1231-1238
• 34 Meredith IT, Broughton A, Jennings GL, Esler MD. Evidence of a selective increase in cardiac sympathetic activity in patients with sustained ventricular arrhythmias.  N Eng J Med. 1991;  325 618-624
• 35 Musselman DL, Evans DL, Nemeroff CB. The relationship of depression to cardiovascular disease. Epidemiology, biology and treatment.  Arch Gen Psychiatr. 1998;  55 580-592
• 36 Penninx BWJH, Beckman ATF, Honig A. et al. . Depression and cardiac mortality.  Arch Gen Psychiatr. 1991;  58 221-227
• 37 Pratt LA, Ford DE, Crum RM, Armenian HK, Gallo J, Eaton WW. Depression, psychotropic medication and risk of myocardial infarction.  Circulation. 1996;  94 3123-3129
• 38 Rechlin T, Weis M, Spitzer A, Kaschka WP. Are affective disorders associated with alterations of heart rate variability?.  J Affect Dis. 1994;  32 271-275
• 39 Roose SP, Yeragani V. Antidepressants and mortality in depressed patients with concomitant illness.  Eur Neuropsychopharmacol. 2002;  12 S162
• 40 Schleifer SJ, Macari-Hinson MM, Coyle DA. et al. . The nature and course of depression follwing myocardial infarction.  Arch Intern Med. 1989;  149 1785-1789
• 41 Schwartz PJ, La MT Rovere, Vanoli E. Autonomic nervous system and sudden cardiac death. Experimental basis and clinical observations for post myocardial infarction risk stratification.  Circulation. 1992;  85 177-191
• 42 Severus WE, Littman AB, Stoll AL. Omega-3 fatty acids, homocysteine, and increased risk of cardiovascular mortality in major depressive disorder.  Harv Rev Psychiatry. 2001;  9 280-293
• 43 Stein PK, Carney RM, Freedland KE. et al. . Severe depression is associated with markedly reduced heart rate variability in patients with stable coronary heart disease.  J Psychosom Res. 2000;  48 493-500
• 44 Berkman LF, Blumenthal J, Burg M. et al. . Study Group Of Enhancing Recovery In Coronary Heart Disease Patients. Effects of treating depression and low perceived social support on clinical events after myocardial infarction: the Enhancing Recovery in Coronary Heart Disease Patients (ENRICHD) Randomized Trial.  JAMA. 2003;  289 3106-3116
• 45 Verrier RL, Calvert A, Lown B. Effect of posterior hypothalamic stimulation on ventricular fibrillation threshold.  Am J Physiol. 1975;  228 923-927
• 46 Vogt T, Pope C, Mullooly J, Hollis J. Mental health status as a predictor of morbidity and mortality: a 15-year follow-up of members of a health maintenance organization.  Am J Public Health. 1994;  84 227-231
• 47 Wenzel RR, Siffert W, Bruck H, Philipp T, Schafers RF. Enhanced vasoconstriction to endothelin-1, angiotensin II and noradrenaline in carriers of the GNB3 825T allele in the skin microcirculation.  Pharmacogenetics. 2002;  12 489-495
• 48 Wetterling T, Junghanns K. Gerontopsychiatrischer Konsiliardienst.  Psychiatr Prax. 2002;  29 311-314
• 49 Whyte EM, Pollock BG, Wagner WR. et al. . Influence of serotonin transporter promotor region polymorphism on patelet activation in geriatric depression.  Am J Psychiatry. 2001;  158 2074-2076
• 50 Zaza A, Schwartz PJ. Role of the autonomic nervous system in the genesis of early ischemic arrhythmias.  J Cardiovasc Pharmacol. 1985;  7 S8-S12

Korrespondenzadresse: