Fortschr Neurol Psychiatr 2002; 70(5): 268-275
DOI: 10.1055/s-2002-28434
Originalarbeit
© Georg Thieme Verlag Stuttgart · New York

Depression und koronare Herzerkrankung: pathogenetische Faktoren vor dem Hintergrund des Stresskonzeptes

Depression and Cardiovascular Disease: Pathogenetic Factors of the Stress ConceptM.  Deuschle1 , F.  Lederbogen1
  • 1Zentralinstitut für Seelische Gesundheit, Mannheim (Direktor: Prof. Dr. Dr. F. A. Henn)
Further Information

Publication History

Publication Date:
08 May 2002 (online)

Zusammenfassung

Kardiovaskuläre Erkrankungen sind immer noch mit Abstand die häufigsten Todesursachen in der westlichen Welt. Eine Vielzahl prospektiver Untersuchungen zeigt nun, dass initial herzgesunde Menschen ein höheres Risiko für kardiovaskuläre Ereignisse aufweisen, wenn bei Beobachtungsbeginn einzelne depressive Symptome oder ein depressives Syndrom vorlagen. Umgekehrt ist bei Patienten nach einem Myokardinfarkt ein depressives Syndrom mit einer schlechten kardialen Prognose vergesellschaftet. Die Kenntnis der pathophysiologischen Zusammenhänge zwischen affektiver und kardialer Erkrankung ist natürlich wesentlich, um eine bessere Prophylaxe kardialer Ereignisse bei depressiven Patienten zu gewährleisten. Während depressiver Episoden kommt es zu einer Aktivierung der Stress-Systeme, die wesentlich zu metabolischen und autonomen Risikovariablen beitragen können. Diese Übersicht fasst den aktuellen Stand der Kenntnisse in diesem Bereich zusammen.

Abstract

To date cardiovascular disorders still represent the most frequent cause of death in our western hemisphere. A number of prospective studies have now been able to show that patients with no prior history of heart disease run a higher risk of developing cardiovascular problems, if they either suffered a number of depressive symptoms or showed a depressive syndrome. Similarly, in patients who have suffered a myocardial infarction the presence of a depressive syndrome is frequently associated with poor clinical prognosis and outcome. Within this context the knowledge of the pathophysiological relationship between affective and cardiovascular disorders constitutes an essential element for instituting effective preventive measures for protecting depressed patients against the risk of suffering cardiovascular problems. The activation of stress-responsive systems during depressive episodes may contribute to metabolic risk factors and dysbalance of the autonomic heart regulation. The present overview provides a summary of current knowledge and findings within this area of research.

 Literatur

  • 1 Adams P B, Lawson S, Sanigorski A, Sinclair A J. Arachidonic acid to eicosapentanoic acid ratio in blood correlates positively with clinical symptoms of depression.  Lipids. 1996;  31(suppl) 157-161
  • 2 Agelink M, Majewski T, Wurthmann C, Postert T, Linka T, Rotterdam S, Klieser E. Autonomic neurocardiac function in patients with major depression and effects of antidepressive treatment with nefazodone.  J Affective Disord. 2001;  62 187-198
  • 3 Ahern D K, Gorkin L, Anderson J L, Tierney C, Hallstrom A, Ewart C, Capone R J, Schron E, Kornfeld D, Herd J A, Richardson D W, Follick M J. For the CAPS investigators. Biobehavioral variables and mortality or cardiac arrest in the Cardiac Arrhythmia Pilot Study (CAPS).  Am J Cardiol. 1990;  66 59-62
  • 4 Allison T G, Williams D E, Miller T D, Patten C A, Bailey K R, Squires R W, Gau G T. Medical and economic costs of psychologic distress in patients with coronary artery disease.  Mayo Clin Proc. 1995;  70 734-742
  • 5 Anda R, Williamson D, Escobedo L G, Mast E E, Giovino G A, Remington L. Depression and the dynamics of smoking. A national perspective.  JAMA. 1990;  264 1541-1545
  • 6 Anda R, Willliamson D, Jones D, Macera C, Eaker E, Glassman A, Marks J. Depressed affect, hopelessness and the risk of ischemic heart disease in a cohort of U.S. adults.  Epidemiology. 1993;  4 285-294
  • 7 Appels A, Falger P R, Schouten E G. Vital exhaustion as risk indicator for myocardial infarction in women.  J Psychosom Res. 1993;  37 881-890
  • 8 Aromaa A, Raitasalo R, Reunanen A, Impivaara O, Heliövaara M, Knekt P, Lehtinen V, Joukamaa M, Maatela J. Depression and cardiovascular diseases.  Acta Psychiatr Scand (suppl). 1994;  377 77-82
  • 9 Avorn J, Everitt D E, Weiss S. Increased antidepressant use in patients prescribed β-blockers.  JAMA. 1986;  255 357-360
  • 10 Barefoot J C, Schroll M. Symptoms of depression, acute myocardial infarction and total mortality in a community sample.  Circulation. 1996;  93 1976-1980
  • 11 Barefoot J C, Helms M J, Mark D B, Blumenthal J A, Califf R M, Haney T L, O'Connor C M, Siegler I C, Williams R B. Depression and long-term mortality risk in patients with coronoary artery disease.  Am J Cardiol. 1996;  78 613-617
  • 12 Barefoot J C, Brummett B H, Helms M J, Mark D B, Siegler I C, Williams R B. Depressive symptoms and survival of patients with coronary artery disease.  Psychosomatic Med. 2000;  62 790-795
  • 13 Blumenthal J A, Williams R S, Wallace A G, Williams R B, Needles T L. Physiological and psychological variables predict compliance to prescribed therapy in patients recovering from myocardial infarction.  Psychosom Med. 1982;  44 519-527
  • 14 Breslau N, Kilbey M M, Andreski P. Vulnerability to psychopathology in nicotine-dependent smokers: an epidemiologic study of young adults.  Am J Psychiatry. 1993;  150 941-946
  • 15 Carels R A, Sherwood A, Babyak M, Gullette E CD, Coleman R E, Waugh R, Jiang Wei, Blumenthal J A. Emotional responsivity and transient myocardial ischemia.  J Consult Clin Psychol. 1999;  67 605-610
  • 16 Carney R M, Freedland K E, Eisen S A, Rich M W, Jaffe A S. Major depression and medication adherence in elderly patients with coronary artery disease.  Health Psychol. 1995;  14 88-90
  • 17 Carney R M, Saunders R D, Freedland K E, Stein P, Rich M W, Jaffe A S. Association of depression with reduced heart rate variability in coronary artery disease.  Am J Cardiol. 1995;  76 562-564
  • 18 Carney R M, Rich M W, te Velde A, Saini J, Clark K, Freedland K E. The relationship between heart rate, heart rate variability and depression in patients with coronary artery disease.  J Psychosom Res. 1988;  32 159-164
  • 19 Carney R M, Rich M W, Freedland K E, Saini J. Major depressive disorder predicts cardiac events in patients with coronary artery disease.  Psychosom Med. 1988b ;  50 627-633
  • 20 Carney R M, Rich M W, Tevelde A J, Saini J, Clark K, Jaffe A S. Major depressive disorders in coronary artery disease.  Am J Cardiol. 1987;  60 1273-1275
  • 21 Davidson K, Jonas B, Dixon K, Markovitz J. Do depressive symptoms predict early hypertension incidence in young adults from the CARDIA study?.  Arch Intern Med. 2000;  160 1495-1500
  • 22 de Groot M, Jacobson A M, Samson J A, Welch G. Glymecic control and major depression in patients with type 1 and type 2 diabetes mellitus.  J Psychosom Res. 1999;  46 425-435
  • 23 Deuschle M, Lederbogen F, Weber B, Gernoth C, Heuser I. (submitted): Flattened circadian blood pressure regulation in depressed patients. 
  • 24 Denollet J, Sys S U, Brutsaert D L. Personality and mortality after myocardial infarction.  Psychosom Med. 1995;  57 582-591
  • 25 Denollet J, Sys U S, Stroobant N, Rombouts H, Gillebert T C, Brutsaert D L. Personality as independent predictor of long-term mortality in patients with coronary heart disease.  Lancet. 1996;  347 417-421
  • 26 Druss B G, Bradford D W, Rosenheck R A, Radford M J, Krumholz H M. Mental disorders and use of cardiovascular procedures after myocardial infarction.  JAMA. 2000;  283 506-511
  • 27 Eaton W W, Armenian H, Gallo J, Pratt L, Ford D E. Depression and the risk for onset of type II diabetes.  Diab Care. 1996;  19 1097-1102
  • 28 Everson S A, Goldberg D E, Kaplan G A, Cohen R D, Puikkala E, Tuomilehto J, Salonen J T. Hopelessness and risk of mortality and incidence of myocardial infarction and cancer.  Psychosom Med. 1996;  58 113-121
  • 29 Ford D E, Mead L A, Chang P P, Cooper-Patrick L, Wang N Y, Klag M J. Depression is a risk factor for coronary artery disease in men.  Arch Intern Med. 1998;  158 1422-1426
  • 30 Frasure-Smith N. Lesperance F, Talajic M. Depression following myocardial infarction. Impact on 6-month survival.  JAMA. 1993;  270 1819-1825
  • 31 Frasure-Smith N, Lesperance F, Talajic M. Depression and 18-month prognosis after myocardial infarction.  Circulation. 1995;  91 999-1005
  • 32 Frasure-Smith N, Lesperance F, Juneau M, Talajic M, Bourassa M G. Gender, depression and one-year prognosis after myocardial infarction.  Psychosom Med. 1999;  61 26-37
  • 33 Gavard J A, Lustman P J, Cluse R E. Prevalence of depression in adults with diabetes.  Diabetes Care. 1993;  16 1167-1178
  • 34 Georgiades A, Lemne C, de Faire U, Lindvall K, Fredrikson M. Stress-induced blood pressure measurements predict left ventricular mass over three years among borderline hypertensive patients.  Eur J Clin Invest. 1997;  27 733-739
  • 35 Giovino G A, Henningfield J E, Tomar S L, Escobedo L G, Slade J. Epidemiology of tobacco use and dependence.  Epidemiol Rev. 1995;  17 48-65
  • 36 Glassman A H, Johnson L L, Giardina E G, Walsh B T, Roose S P, Cooper T B, Bigger Jr J T. The use of imipramine in depressed patient with congestive heart failure.  JAMA. 1983;  250 1997-2001
  • 37 Glassman A H, Roose S P, Bigger J T. The safety of tricyclic antidepressants in cardiac patients: risk/benefit reconsidered.  JAMA. 1993;  269 2673-2675
  • 38 Glassman A H. Cardiovascular effects of antidepressant drugs: updated.  J Clin Psychiatry. 1998;  59 (suppl 15) 13-18
  • 39 Gonzalez M B, Snyderman T B, Colket J T, Arias R M, Jiang J W, O'Connor C M, Krishnan K R. Depression in patients with coronary artery disease.  Depression. 1996;  4 57-62
  • 40 Gotthardt U, Schweiger U, Farhenberg J, Lauer C J, Holsboer F, Heuser I. Cortisol, ACTH and cardiovascular response to a cognitive challenge paradigm in aging and depression.  Am J Physiol. 1995;  268 R865-R873
  • 41 Gullette E C, Blumenthal J A, Babyak M, Jiang W, Waugh R A, Frid D J, O'Connor C M, Morris J J, Krantz D S. Effects of mental stress on myocardial ischemia during daily life.  JAMA. 1997;  277 1521-1526
  • 42 Hällström T, Lapidus L, Bengtsson C, Edström K. Psychosocial factors and risk of ischaemic heart disease and death in women: a twelve-year follow-up of participants in the populationstudy of women in Gothenburg, Sweden.  J Psychosom Res. 1986;  30 451-459
  • 43 Haines A P, Ineson J D, Meade T W. Phobic anxiety and ischemic heart disease.  Br Med J. 1987;  295 297-299
  • 44 Hallas J. Evidence of depression provoked by cardiovascular medication: a prescription sequence symmetry analysis.  Epidemiology. 1996;  7 478-484
  • 45 Hemingway H, Marmot M. Evidence based cardiology: psychosocial factors in the aetiology and prognosis of coronary heart disease: systemic review of prospective cohort studies.  BMJ. 1999;  318 1460-1467
  • 46 Jonas B S, Franks P, Ingram D D. Are symptoms of anxiety and depression risk factors for hypertension?.  Arch Fam Med. 1997;  6 43-49
  • 47 Kamarck T W, Everson S A, Kaplan G A, Manuck S B, Jennings J R, Salonen R, Salonen J T. Exaggereated blood pressure responses during mental stress are associated with enhanced carotid atherosclerosis in middle-aged Finnish men: findings from the Kuopio Ischemic Heart Disease Study.  Circulation. 1997;  96 3842-3848
  • 48 Kandel D B, Davies M. Adult sequelae of adolescent depressive symptoms.  Arch Gen Psychiatry. 1986;  43 255-262
  • 49 Kaufmann M W, Fitzgibbons J P, Sussman E J, Reed J F, Einfalt J M, Rodgers J K, Fricchione G L. Relation between myocardial infarction, depression, hostility and death.  Am Heart J. 1999;  138 549-554
  • 50 Kawachi I, Sparrow D, Vokonas P S, Weiss S T. Symptoms of anxiety and risk of coronary heart disease. The Normative Aging Study.  Circulation. 1994;  90 2225-2229
  • 51 Kendler K S, Neale M C, MacLean C J, Heath A C, Eaves L J, Kessler R C. Smoking and major depression. A causal analysis.  Arch Gen Psychiatry. 1993;  50 36-43
  • 52 Kennedy G J, Hofer M A, Cohen D, Shindledecker R, Fisher J D. Significance of depression and cognitive impairment in patients undergoing programed stimulation of cardiac arrhythmias.  Psychosom Med. 1987;  49 410-421
  • 53 Kloner R A, Leor J, Poole W K, Perritt R. Population-based analysis of the effect of the Northridge Earthquake on cardiac death in Los Angeles County, California.  J Am Coll Cardiol. 1997;  30 1174-1180
  • 54 Kop W J, Appels A, de Leon C F, de Swart H B, Bar F W. Vital exhaustion predicts new cardiac events after successful coronary angioplasty.  Psychosom Med. 1994;  56 281-287
  • 55 Krittayaphong R, Cascio W R, Light K C, Sheffield D, Golden R N, Finkel J B, Glekas G, Koch G G, Sheps D S. Heart rate variability in patients with coronary artery disease: differences in patients with higher and lower depression scores.  Psychosom Med. 1997;  59 231-235
  • 56 Kromhout D, Bosschieter E B, Coulander C. The inverse relation between fish consumption and 20-year mortality from coronary heart disease.  New Engl J Med. 1985;  312 205-209
  • 57 Kubzansky L D, Kawachi I, Spioro A, Weiss S T, Vokonas P S, Sparrow D. Is worrying bad for your brain ? A prospective study of worry and coronary heart disease in the Normative Aging Study.  Circulation. 1997;  95 814-824
  • 58 Ladwig K H, Breithardt G, Budde T, Borggrefe M. Post-infarction depression and incomplete recovery 6 months after acute myocardial infarction.  Lancet. 1994;  343 20-23
  • 59 Laghrissi-Thode F, Wagner W R, Pollock B R, Johnson P C, Finkel M S. Elevated platelet factor 4 and β-thromboglobulin plasma levels in depressed patients with ischemic heart disease.  Biol Psychiatry. 1997;  42 290-295
  • 60 Lampert R, Jain D, Burg M M, Batsford W P, McPherson C A. Destabilizing effects of mental stress on ventricular arrhythmias in patients with implantable cardioverter-defibrillators.  Circulation. 2000;  101 158-164
  • 61 Lane D, Carroll D, Ring C, Beevers D G, Lip G YH. Effects of depression and anxiety on mortality and quality of life 4 months after myocardial infarction.  J Psychosomatic Res. 2000;  49 229-238
  • 62 Lane D, Carroll D, Ring C, Beevers D G, Lip G Y. Mortality and quality of life 12 months after myocardial infarction: effects of depression and anxiety.  Psychosomatic Med. 2001;  63 221-230
  • 63 Lederbogen F, Gernoth C, Wber B, Colla M, Kniest A, Heuser I, Deuschle M. Antidepressive treatment with amitriptyline and paroxetine: comparable effects on heart rate variability.  J Clin Psychopharmacology. 2001;  21 238-239
  • 64 Lederbogen F, Maras A, Weber B, Colla M, Gilles M, Heuser I, Deuschle M. Increased platelet aggregability in major depression.  Psychiatry Res. 2001;  102 255-261
  • 65 Leedom L, Meehan W P, Procci W, Zeidler A. Symptoms of depression in patients with type II diabetes mellitus.  Psychosomatics. 1991;  32 280-286
  • 66 Loyke H F. Cold pressure test as a predictor of the severity of hypertension.  South Med J. 1995;  88 300-304
  • 67 Maes M, Smith R, Christophe A, Cosyns P, Desnyder R, Meltzer H. Fatty acid composition in major depression: decreased w3 fractions in cholesteryl esters and increased C20 : 4omega6/C20 : 5omega3 ratio in cholesteryl esters and phsopholipids.  J Affect Disord. 1996;  38 35-46
  • 68 Malkoff S B, Muldoon M F, Zeigler Z R, Manuck S B. Blood platelet responsivitiy to acute mental stress.  Psychosom Med. 1993;  55 477-482
  • 69 Malzberg B. Mortality among patients with involution melancholia.  Am J Psychiatry. 1937;  93 1231-1238
  • 70 Markovitz J H, Matthews K A. Platelets and coronary heart disease: potential psychophysiological mechanisms.  Psychosom Med. 1991;  53 643-668
  • 71 Markovitz J H, Matthews J H, Kannel W B, D'Agostino R B. Psychological predictors of hypertension in the Framingham Study: is there tension in hypertension?.  JAMA. 1993;  270 2439-2443
  • 72 Markovitz J H, Matthews K A, Kiss J, Smitherman T C. Effects of hostility on platelet reactivity to psychological stress in coronary heart disease patients and in healthy controls.  Psychosom Med. 1996;  58 143-149
  • 73 Markovitz J H, Raczynski J M, Wallace D, Chettur V, Chesney M A. Cardiovascular reactivity to video game predicts subsequent blood pressure increases in young men: the CARDIA study.  Psychosom Med. 1998;  60 186-191
  • 74 Marcus M D, Wing R R, Guare J, Blair E H, Jawad A. Lifetime prevalence of major depression ad its effect on treatment outcome in obese type II diabetic patients.  Diabetes Care. 1992;  15 253-255
  • 75 Matthews K A, Woodall K L, Allen M T. Cardiovascular reactivity to stress predicts future blood pressure status.  Hypertension. 1993;  22 479-485
  • 76 Murphy J M, Monson R R, Olivier D C, Sobol A M, Pratt L A, Leighton A H. Mortality risk and psychiatric disorders.  Soc Psychiatry Psyiatr Epidemiol. 1989;  24 134-142
  • 77 Musselman D L, Tomer A, Manatunga A K, Knight B T, Porter M R, Kasey S, Marzec U, Harker L A, Nemeroff C B. Exaggerated platelet reactivity in major depression.  Am J Psychiatry. 1996;  153 1313-1317
  • 78 Orth-Gomer K, Edwards M, Erhardt L, Sjorgren A, Theorell T. Relation between ventricular arrhythmias and psychological profile.  Acta Med Scand. 1980;  207 31-36
  • 79 Partonen T, Haukka J, Virtamo J, Taylor P R, Lönnqvist J. Association of low serum total cholesterol with major depression and suicide.  Br J Psychiatry. 1999;  175 259-262
  • 80 Peet M, Murphy B, Shay J, Horrobin D. Depletetion of omega-3 fatty acid levels in red blood cell membranes of depressive patients.  Biol Psychiatry. 1998;  43 315-319
  • 81 Penninx B, Beekman A, Honig A, Deeg D, Schoevers R, van Eijk J, van Tilburg W. Depression and cardiac mortality.  Arch Gen Psychiatry. 2001;  58 221-227
  • 82 Penttilä J, Syvälahti E, Hinkka S, Kuusela T, Scheinin H. The effects of amitriptyline, citalopram and reboxetin on autonomic nervous system.  Psychopharmacology. 2001;  154 343-349
  • 83 Pfohl B, Rederer M, Coryell W, Stangl D. Association between post-dexamethasone cortisol level and blood pressure in depressed patients.  J Nerv Ment Dis. 1991;  178 44-47
  • 84 Piletz J E, Zhu H, Madakasira S, Pazzaglia P, DeVane C L, Goldman N, Halaris A. Elevated p-selectin on platelets in depression: response to bupropion.  J Psychiatric Res. 2000;  34 397-404
  • 85 Post R M. Transduction of psychosocial stress into neurobiology of recurrent affective disorder.  Am J Psychiatry. 1992;  149 999-1010
  • 86 Pratt L A, Ford D E, Crum R M, Armenian H K, Gallo J J, Eaton W W. Depression, psychotropic medication and risk of myocardial infarction: prospective data from the Baltimore ECA follow-up.  Circulation. 1996;  94 3123-3129
  • 87 Rathmann W, Haastert B, Roseman J M, Giani G. Cardiovascular drug prescriptions and risk of depression in diabetic patients.  J Clin Epidemiol. 1999;  52 1103-1109
  • 88 Reich P. Psychological predisposition to life-threatening arrhythmias.  Annu Rev Med. 1985;  36 397-405
  • 89 Roose S P, Glassman A H, Giardina E GV, Walsh B T, Woodring S, Bigger T. Tricyclic antidepressants in depressed patients with cardiac conduction disease.  Arch Gen Psychiatry. 1987;  44 273-275
  • 90 Roose S P, Glassman A H, Attia E, Woodring S, Giardina E G, Bigger Jr J T. Cardiovascular effects of fluoxetine in depressed patients with heart disease.  Am J Psychiatry. 1998;  155 660-665
  • 91 Roose S P, Laghrissi-Thode F, Kennedy J S, Nelson C, Bigger J T, Pollock B G, Gaffney A, Narayan M, Finkel M S, McCafferty J, Gergerl I. Comparison of paroxetine and nortriptyline in depressed patients with ischemic heart disease.  JAMA. 1998;  279 287-291
  • 92 Sachs G, Spiess K, Moser G, Prager R, Kunz A, Schernthaner G. Glycosylated hemoglobin and diabetes self-monitoring (compliance) in depressed and non-depressed type I diabetic patients.  Psychother Psychosom Med Psychol. 1991;  41 306-312
  • 93 Schleifer S J, Macari-Hinson M M, Coyle D A, Slater W R, Kahn M, Gorlin R, Zucker H D. The nature and course of depression following myocardial infarction.  Arch Intern Med. 1989;  149 1785-1789
  • 94 Serebruany V L, O'Connor C M, Gurbel P A. Effect of selective serotonin reuptake inhibitors on platelets in patients with coronary artery disease.  Am J Cardiol. 2001;  87 1398-1400
  • 95 Shapiro P A, Lesperance F, Frasure-Smith N, O'Connor C M, Baker B, Jiang J W, Dorian P, Harrison W, Glassman A H. An open-label preliminary trial of sertraline for treatment of major depression after acute myocardial infarction (the SADHAT Trial).  Am Heart J. 1999;  137 1100-1106
  • 96 Strik J, Honig A, Lousberg R, Lousberg A, Cheriex E, Tuynman-Qua H, Kuijpers P, Wellens H, van Praag H. Efficacy and safety of fluoxetine in the treatment of patients with major depression after first myocardial infarction: findings from a double-blind placebo-controlled study.  Psychosomatic Med. 2000;  62 783-789
  • 97 Tanskanen A, Hibbeln J, Tuomilehto J, Uutela A, haukkala A, Viinamäki H, Lehtonen J, Vartiainen E. Fish consumption and depressive symptoms in the general population in Finland.  Psychiatric Services. 2001;  52 529-531
  • 98 Timio M, Lippi G, Venanzi S, Gentili s, Quintaliani G, Verdura C, Monarca C, Saronio P, Timio F. Blood pressure trend and cardiovascular events in nuns in a secluded order: a 30-year follow-up study.  Blood Press. 1997;  6 81-87
  • 99 van Ravemswaaij-Arts C M, Kollée L A, Hopman J C, Stoelinga G B, van Geijn H P. Heart rate variability.  Ann Intern Med. 1993;  118 436-447
  • 100 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
  • 101 Wassertheil-Smoller S, Applegate W B, Berge K, Chang C J, Davis B R, Grimm Jr R, Kostis J, Pressel S, Schron E. Change in depression as a precursor of cardiovascular events. SHEP Cooperative Research Group (Systolic Hypertension in the elderly).  Arch Intern Med. 1996;  156 553-561
  • 102 Watkins L L, Grossman P. Association of depressive symptoms with reduced baroreflex cardiac control in coronary artery disease.  Am Heart J. 1999;  137 453-457
  • 103 Watkins L L, Grossman P, Krishnan R, Blumenthal J A. Anxiety reduces baroreflex cardiac control in older adults with major depression.  Psychosom Med. 1999;  61 334-340
  • 104 Weber B, Schweiger U, Deuschle M, Heuser I. Major Depression and impaired glucose tolerance.  Exp Clin Endocrinol Diabet. 2000;  108 187-190
  • 105 Yeung A C, Vekshtein V I, Krantz D S, Vita J A, Ryan Jr T J, Ganz P, Selwyn A P. The effect of atherosclerosis on the vasomotor response of coronary arteries to mental stress.  N Engl J Med. 1991;  325 551-556

PD Dr. med. M. Deuschle

Zentralinstitut für Seelische Gesundheit · Klinik für Psychiatrie und Psychotherapie

J5, 68159 Mannheim

Email: deuschle@as200.zi-mannheim.de

    >