Depression, Vital Exhaustion and recurrent heart disease

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Depression, Vital Exhaustion and recurrent heart
disease
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Lecture 9 references Standard texts, Kop paper,
and Krantz Lundgren paper. Depression and CHD
is very current topic and good reviews are just
appearing. Psychosomatic Medicine has made a
complete special issue on the topic available
over the internet (free). Go to
www.psychosomaticmedicine.org Kubzansky Kawachi
2000. Going to the heart of the matter do
negative emotions cause coronary heart disease? J
Psychosomatic Res., 48, 323-327 Review that
includes depression. Carney, R M., Freedland,
Miller, M (2002) Depression as a risk factor for
cardiac mortality and morbidityA review of
potential mechanisms. J Psychosomatic Res., 53,
897-902. Thoughtful discussion that is worth
reading.
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Depression what is it? DSM-IV Five of following
for at least 2 weeks Sad mood most of day, most
days Loss of interest pleasure in usual
activities Sleeping difficulties Change in
activity level Change in eating
patterns Fatigue Negative view of self Less
efficient thinking Recurrent thoughts of suicide
or death
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Frasure-Smith et al, 1999. Gender, depression and
one-year prognosis after myocardial infarction.
Psychosomatic Med. 61, 26-37. (On web through
library, worth reading). See also her paper on
special issue of Psychosomatic Medicine referred
to earlier Nancy Frasure-Smith major figure in
proposing that depression makes reinfarction more
likely. In this paper she combines her earlier
studies to get large enough sample to examine
effects of gender. Sample. Women 283, Men 613.
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Frasure-Smith, 1999
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Barefoot et al, 2000 Depressive symptoms and
survival of patients with coronary artery
disease. Psych. Med. 62, 790-795. 1250 patients
with CAD seen between 1974 1980 followed up for
up to 19.4 years. Measure Negative Affect. 6 item
covering Sad, crying, suicidal thoughts,
irritability, restlessness
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High negative affect (overlaps with depression),
associated with lower survival in younger patients
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Vital Exhaustion (Ad Appels), see
Kop Features lack of energy increased
irritability demoralization Vital exhaustion is
short term predictor of MI, Rotterdam Civil
Servant study. 3877 healthy men followed up for
4.2 years.
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More coronary events in exhausted patients who
received angioplasty, Kop.
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Mechanisms for Depression CHD link Reactivity.
Preliminary evidence that reactivity may be
increased in depression. Perhaps associated with
anger/irritation. Anti-depressants Other Risk
factors Heart disease severity Adherence and
other behavioural mechanisms Autonomic tone Blood
clotting processes. PF4 and BTG increased in
depressed CHD patients Inflammatory processes.
Evidence of increased inflammation related to
chlamydia in exhausted patients with CAD (Appels
2000). See Kop in special issue of Psychosomatic
Medicine.
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Studies in Health populations Kuper Marmot
Hemingway (2002), Seminars in Vascular
Medicine,2, 267-313 Psychological
process positive/no. of studies Type A /
Hostility 6/18 Depression 15/22 Anxiety
4/8 Work characteristics 10/13 (Social
Support 6/9) Studies in Populations with
Cardiovascular Disease Type A/Hostility
2/15 Depression 18/34 Anxiety 8/18 Work
characteristics 2/4 (Social Support
14/21) Seen as positive support overall By K,M
H
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Evidence from interventions
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ENRICHD trial of reduction of Depression and/or
increase in Perceived Social Support. No effect
on Recurrent MI but very little effects on
Depression or Social Support
Effects on Depression BDI at only 6 months Pre
6 month Usual Care 18.0 12.2 Intervention 17.7 9.
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ENRICHD (2003). Treatment of depression and low
perceived social support after myocardial
infarction JAMA, 289, 3106-3116
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Reduction in Vital Exhaustion after Angioplasty.
No effect on new coronary events but effect on
Exhaustion restricted to sub-sample of patients

Effects on Exhaustion at 18 months No history
of CAD Int. Cntrl Not
Exhausted 56 38 Exhausted
44 62 History of CAD Int.
Cntrl Not Exhausted
47 47 Exhausted 53 53
Appels, A et al., (2005) Effects of treating
exhaustion in angioplasty patients on new
coronary events. Psychosom Med 67, 217-223
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Depression reduced in patients after MI by simple
Counselling intervention
Johnston,M, Foulkes J, Johnston, D, Pollard, B,
Gudmundsdottir, H (1999) Psychosomatic Medicine,
61, 225-233
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Depression reduced in partners of MI patients who
received counselling
Johnston,M, Foulkes J, Johnston, D, Pollard, B,
Gudmundsdottir, H (1999) Psychosomatic Medicine,
61, 225-233