Antidepressive Therapy in Myocardial Infarction, Prevents Recurrent Cardiovascular Events?
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2019, Vol 13, Issue 4
Abstract
There is an endorsement from American Heart Association that depression should be considered a risk factor of heart disease and recommends its screening as part of routine practice. However, all experts do not agree due to controversy on account of inconsistencies in the evidence linking treatment of depression to improved outcomes in Cardiovascular Diseases (CVDs). Further evidence indicates that chrono-behavioral and chrono-physiological dysfunctions can predispose traditional risk factors of CVDs as well as other psychological disorders including depression. Recently, reduced duration of sleep which is a risk factor of depression has also been reported to be risk factors of CVDs. Chronic mood disorders such as depression are also known to predispose acute Myocardial Infarction (MI). The incidence of depression may be three-fold higher among Acute Coronary Syndrome (ACS) patients compared to the control subjects. Therefore, there is a need to treat depression to prevent CVDs. Depression can increase amygdalar activity in the brain, which could be examined as tremors in the amygdala by Functional Magnetic Resonance Imaging (fMRI). The activation of amygdala may be associated with increased bone marrow activity and inflammation with increased hsCRP. Western diet is a possible risk factor of depression as well as myocardial infarction, and both are associated with oxidative stress and inflammation. Hence Mediterranean styles diets that are anti-inflammatory, may be used for the preventions of both the diseases. Recent clinical trials in subjects with depression after recent myocardial infarction revealed that antidepressant therapy with escitalopram can cause a lower risk of major cardiovascular events. Further studies are needed to establish the role of antidepressants, along with Mediterranean style diets, in the management of depression in patients with ACS.Apart from the traditional risk factors, non-traditional risk factors; late-night sleep, late-night eating, heavy meals, psychosocial stress, and sleep deprivation are called chrono-behavioral risk factors of Acute Coronary Syndrome (ACS) or Myocardial Infarction (MI) [1-3]. These chrono-behavioral and chronophysiological dysfunctions can predispose the traditional risk factors of Cardiovascular Diseases (CVDs), as well as chronic anxiety disorders such as depression leading to MI [4-10]. Recently, duration of sleep which is a risk factor of depression has also been reported to be risk fac tors of CVDs [11]. Chronic mood disorders such as depression have become important risk factors of ACS, which can explain much of the hidden risk that increases the vulnerability of MI patients to increased cardiovascular events [8-11]. Despite increases in the use of modern drug therapy and interventions, the residual risk of death, MI, or stroke up to 1 year after acute MI remains high. There is a need to control this risk by preventing adverse effects of elevated glucose, inflammation, oxidative stress and chronic mood disorders, such as depression by nutritional modification and drug therapy, because increased risk of recurrent cardiovascular events, among these patients, appears to be related to mood disorders such as depression.Recently, American Heart Association (AHA) has advised that depression should be considered as a risk factor CVDs and therefore screening for this entity should be as part of clinical practice [5]. However, it has been met with controversy because of inconsistencies in the data that have been used to link treatment of depression leading to improved outcomes in CVDs. This narrative and selective review aims to emphasize that treatment of depression by drug therapy and nutritional intervention may be beneficial in patients with CVDs.
Authors and Affiliations
Ram B Singh, Viliam Mojto, Jan Fedacko, Galal Elkilany, Krasimira Hristova, Agnieszka Wilczynska, Dr Kumar Kartikey
Keywords
Related Articles
- EP ID EP594720
- DOI 10.26717/BJSTR.2019.13.002421
- Views 178
- Downloads 0
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