Do antidepressants have a role in preventive medicine

1
Do antidepressants have a role in preventive
medicine?
2
Introduction

• Chronic, uncontrolled stress can lead to medical
  problems in the long-term
• Depression and anxiety are themselves stressors
• Clinical evidence demonstrates how mood disorders
  are also associated with persistent
  stress-related medical disorders

3
Anxiety-Depression-Stress
? stress response
Stress
CRH
Cortisol
ACTH
Adrenal Glands
Pro-inflammatory Cytokines
Epi, NE
Sensitization at many levels
4
Anxiety and Depression Become Health Risks

• Anxious/depressed patients have an over
  stimulated HPA response
• Stressed individuals release more
  pro-inflammatory cytokines
• Uncontrolled stress is linked to a variety of
  medical disorders
• Cardiovascular
• Metabolic disorders
• Immunologic dysfunction
• Neuroendocrine dysfunction

5
Cytokines and depressive symptomatology

• Sick syndrome from pro-inflammatory cytokines
  resembles depression
• (e.g. anhedonia, fatigue, social withdrawal,
  sad mood)
• Pre-treatment with anti-depressants can prevent
  symptoms of sick syndrome
• Does this mean cytokines are actually a source
  for depression?
• Supporting evidence
• Cytokines shown to activate HPA axis
• Cytokines known to elicit greater neural
  sensitization in areas involved in stress
  response

6
Antidepressants as anti-inflammatories?

• Antidepressants shown to reduce pro-inflammatory
  cytokines
• in vitro
• animal models
• depressed patients
• Antidepressants can reduce pro-inflammatory
  cytokines and increase anti-inflammatory
  cytokines in humans
• Antidepressants, by their anti-inflammatory
  action, may prevent long-term adverse health
  outcomes as well as depressive symptoms

7
Summary

• Continuous anxiety/depression, like stress, can
  lead to cyclical pro-inflammatory reactions
• A continuous pro-inflammatory state can lead to
  subsequent medical disorders
• Antidepressants may help to reduce these chronic
  pro-inflammatory conditions
• First line treatment of these mood disorders can
  help to prevent potential medical disorders in
  the long run