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Is There a High-Risk Subtype of Depression in Patients with Coronary Heart Disease?

  • MEDICOPSYCHIATRIC DISORDERS (WJ KATON, SECTION EDITOR)
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Abstract

Depression is a risk factor for cardiac morbidity and mortality in patients with coronary heart disease, especially in those with a recent history of acute coronary syndrome. To improve risk stratification and treatment planning, it would be useful to identify the characteristics or subtypes of depression that are associated with the highest risk of cardiac events. This paper reviews the evidence concerning several putative depression subtypes and symptom patterns that may be associated with a high risk of morbidity and mortality in cardiac patients, including single-episode major depressive disorder, depression that emerges after a cardiac event, somatic symptoms of depression, and treatment-resistant depression.

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References

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  1. Carney RM, Freedland KE. Depression in patients with coronary heart disease. Am J Med. 2008;121(11 Suppl 2):S20–7.

    Article  PubMed  Google Scholar 

  2. Nicholson A, Kuper H, Hemingway H. Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146 538 participants in 54 observational studies. Eur Heart J. 2006;27(23):2763–74.

    Article  PubMed  Google Scholar 

  3. van Melle JP, de Jonge P, Spijkerman TA, et al. Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: a meta-analysis. Psychosom Med. 2004;66(6):814–22.

    Article  PubMed  Google Scholar 

  4. Barth J, Schumacher M, Herrmann-Lingen C. Depression as a risk factor for mortality in patients with coronary heart disease: a meta-analysis. Psychosom Med. 2004;66(6):802–13.

    Article  PubMed  Google Scholar 

  5. Frasure-Smith N, Lesperance F, Talajic M. Depression following myocardial infarction. Impact on 6-month survival. JAMA. 1993;270(15):1819–25.

    Article  PubMed  CAS  Google Scholar 

  6. Lane D, Carroll D, Ring C, et al. Effects of depression and anxiety on mortality and quality-of-life 4 months after myocardial infarction. J Psychosom Res. 2000;49(4):229–38.

    Article  PubMed  CAS  Google Scholar 

  7. Lespérance F, Frasure-Smith N, Talajic M. Major depression before and after myocardial infarction: its nature and consequences. Psychosom Med. 1996;58(2):99–110.

    PubMed  Google Scholar 

  8. de Jonge P, van den Brink RH, Spijkerman TA, et al. Only incident depressive episodes after myocardial infarction are associated with new cardiovascular events. J Am Coll Cardiol. 2006;48(11):2204–8.

    Article  PubMed  Google Scholar 

  9. Dickens C, McGowan L, Percival C, et al. New onset depression following myocardial infarction predicts cardiac mortality. Psychosom Med. 2008;70(4):450–5.

    Article  PubMed  Google Scholar 

  10. Goodman J, Shimbo D, Haas DC, et al. Incident and recurrent major depressive disorder and coronary artery disease severity in acute coronary syndrome patients. J Psychiatr Res. 2007;42(8):670–5.

    Article  PubMed  Google Scholar 

  11. Grace SL, Abbey SE, Kapral MK, et al. Effect of depression on five-year mortality after an acute coronary syndrome. Am J Cardiol. 2005;96(9):1179–85.

    Article  PubMed  Google Scholar 

  12. Spijkerman T, de Jonge P, van den Brink RH, et al. Depression following myocardial infarction: first-ever versus ongoing and recurrent episodes. Gen Hosp Psychiatry. 2005;27(6):411–7.

    Article  PubMed  Google Scholar 

  13. Berkman LF, Blumenthal J, Burg M, et al. 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(23):3106–16.

    Article  PubMed  Google Scholar 

  14. • Carney RM, Freedland KE, Steinmeyer B et al. History of depression and survival after acute myocardial infarction. Psychosom Med. 2009;71(3):253–259. This study included the largest sample evaluating the prognostic value of first versus recurrent episode of depression and mortality. It also provides an extensive comparison of medical and demographic factors between the groups.

    Article  PubMed  CAS  Google Scholar 

  15. Parker GB, Hilton TM, Walsh WF, et al. Timing is everything: the onset of depression and acute coronary syndrome outcome. Biol Psychiatry. 2008;64(8):660–6.

    Article  PubMed  Google Scholar 

  16. Glassman AH, Bigger Jr JT, Gaffney M. Psychiatric characteristics associated with long-term mortality among 361 patients having an acute coronary syndrome and major depression: seven-year follow-up of SADHART participants. Arch Gen Psychiatry. 2009;66(9):1022–9.

    Article  PubMed  Google Scholar 

  17. Patten SB. Accumulation of major depressive episodes over time in a prospective study indicates that retrospectively assessed lifetime prevalence estimates are too low. BMC Psychiatry. 2009;9:19.

    Article  PubMed  Google Scholar 

  18. Rice JP, Rochberg N, Endicott J, et al. Stability of psychiatric diagnoses. An application to the affective disorders. Arch Gen Psychiatry. 1992;49(10):824–30.

    Article  PubMed  CAS  Google Scholar 

  19. • Zuidersma M, Thombs BD, de JP. Onset and recurrence of depression as predictors of cardiovascular prognosis in depressed acute coronary syndrome patients: a systematic review. Psychother Psychosom. 2011;80(4):227–237. This article provides a thorough, thoughtful review of the literature examining first-time versus recurrent depression, and timing of depression onset in relation to cardiac outcomes.

    Article  PubMed  Google Scholar 

  20. Bush DE, Ziegelstein RC, Tayback M, et al. Even minimal symptoms of depression increase mortality risk after acute myocardial infarction. Am J Cardiol. 2001;88(4):337–41.

    Article  PubMed  CAS  Google Scholar 

  21. Lesperance F, Frasure-Smith N, Talajic M, et al. Five-year risk of cardiac mortality in relation to initial severity and one-year changes in depression symptoms after myocardial infarction. Circulation. 2002;105(9):1049–53.

    Article  PubMed  Google Scholar 

  22. American Psychiatric Association, American Psychiatric Association, Task Force on DSM-IV. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). 4th ed., text revision ed. Washington, DC: American Psychiatric Association; 2000.

  23. Fraguas Jr R, Iosifescu DV, Alpert J, et al. Major depressive disorder and comorbid cardiac disease: is there a depressive subtype with greater cardiovascular morbidity? Results from the STAR*D study. Psychosomatics. 2007;48(5):418–25.

    Article  PubMed  Google Scholar 

  24. Martens EJ, Denollet J, Pedersen SS, et al. Relative lack of depressive cognitions in post-myocardial infarction depression. J Affect Disord. 2006;94(1–3):231–7.

    Article  PubMed  Google Scholar 

  25. de Jonge P, Ormel J, van den Brink RH, et al. Symptom dimensions of depression following myocardial infarction and their relationship with somatic health status and cardiovascular prognosis. Am J Psychiatry. 2006;163(1):138–44.

    Article  PubMed  Google Scholar 

  26. Doyle F, Conroy R, McGee H, et al. Depressive symptoms in persons with acute coronary syndrome: specific symptom scales and prognosis. J Psychosom Res. 2010;68(2):121–30.

    Article  PubMed  Google Scholar 

  27. Hoen PW, Whooley MA, Martens EJ, et al. Differential associations between specific depressive symptoms and cardiovascular prognosis in patients with stable coronary heart disease. J Am Coll Cardiol. 2010;56(11):838–44.

    Article  PubMed  Google Scholar 

  28. Linke SE, Rutledge T, Johnson BD, et al. Depressive symptom dimensions and cardiovascular prognosis among women with suspected myocardial ischemia: a report from the National Heart, Lung, and Blood Institute-sponsored Women's Ischemia Syndrome Evaluation. Arch Gen Psychiatry. 2009;66(5):499–507.

    Article  PubMed  Google Scholar 

  29. Martens EJ, Hoen PW, Mittelhaeuser M, et al. Symptom dimensions of post-myocardial infarction depression, disease severity and cardiac prognosis. Psychol Med. 2010;40(5):807–14.

    Article  PubMed  CAS  Google Scholar 

  30. Roest AM, Thombs BD, Grace SL, et al. Somatic/affective symptoms, but not cognitive/affective symptoms, of depression after acute coronary syndrome are associated with 12-month all-cause mortality. J Affect Disord. 2011;131(1–3):158–63.

    Article  PubMed  Google Scholar 

  31. Schiffer AA, Pelle AJ, Smith OR, et al. Somatic versus cognitive symptoms of depression as predictors of all-cause mortality and health status in chronic heart failure. J Clin Psychiatry. 2009;70(12):1667–73.

    Article  PubMed  Google Scholar 

  32. Smolderen KG, Spertus JA, Reid KJ, et al. The association of cognitive and somatic depressive symptoms with depression recognition and outcomes after myocardial infarction. Circ Cardiovasc Qual Outcomes. 2009;2(4):328–37.

    Article  PubMed  Google Scholar 

  33. Stewart JC, Janicki DL, Muldoon MF, et al. Negative emotions and 3-year progression of subclinical atherosclerosis. Arch Gen Psychiatry. 2007;64(2):225–33.

    Article  PubMed  Google Scholar 

  34. Barefoot JC, Brummett BH, Helms MJ, et al. Depressive symptoms and survival of patients with coronary artery disease. Psychosom Med. 2000;62(6):790–5.

    PubMed  CAS  Google Scholar 

  35. Frasure-Smith N, Lesperance F. Depression and other psychological risks following myocardial infarction. Arch Gen Psychiatry. 2003;60(6):627–36.

    Article  PubMed  Google Scholar 

  36. Hoen PW, Conradi HJ, Denollet J, et al. Interview-based ratings of somatic and cognitive symptoms of depression and their impact on cardiovascular prognosis. Psychother Psychosom. 2010;79(5):319–20.

    Article  PubMed  Google Scholar 

  37. Connerney I, Sloan RP, Shapiro PA, et al. Depression is associated with increased mortality 10 years after coronary artery bypass surgery. Psychosom Med. 2010;72(9):874–81.

    Article  PubMed  Google Scholar 

  38. Pedersen SS, Denollet J, Daemen J, et al. Fatigue, depressive symptoms, and hopelessness as predictors of adverse clinical events following percutaneous coronary intervention with paclitaxel-eluting stents. J Psychosom Res. 2007;62(4):455–61.

    Article  PubMed  Google Scholar 

  39. Tully PJ, Winefield HR, Baker RA, et al. Confirmatory factor analysis of the Beck Depression Inventory-II and the association with cardiac morbidity and mortality after coronary revascularization. J Health Psychol. 2011;16(4):584–95.

    Article  PubMed  Google Scholar 

  40. Carney RM, Freedland KE. Are somatic symptoms of depression better predictors of cardiac events than cognitive symptoms in coronary heart disease? Psychosom Med. 2011; in press.

  41. Brown TA. Confirmatory factor analysis for applied research. New York: Guilford Press; 2006.

    Google Scholar 

  42. Thombs BD, Grace SL, Ziegelstein RC. Do symptom dimensions of depression following myocardial infarction relate differently to physical health indicators and cardiac prognosis? Am J Psychiatry. 2006;163(7):1295–6.

    Article  PubMed  Google Scholar 

  43. Thombs BD, Ziegelstein RC, Stewart DE, et al. Usefulness of persistent symptoms of depression to predict physical health status 12 months after an acute coronary syndrome. Am J Cardiol. 2008;101(1):15–9.

    Article  PubMed  Google Scholar 

  44. Parashar S, Rumsfeld JS, Spertus JA, et al. Time course of depression and outcome of myocardial infarction. Arch Intern Med. 2006;166(18):2035–43.

    Article  PubMed  Google Scholar 

  45. Carney RM, Blumenthal JA, Freedland KE, et al. Depression and late mortality after myocardial infarction in the Enhancing Recovery in Coronary Heart Disease (ENRICHD) study. Psychosom Med. 2004;66(4):466–74.

    Article  PubMed  Google Scholar 

  46. van Melle JP. de JP, Honig A et al. Effects of antidepressant treatment following myocardial infarction. Br J Psychiatry. 2007;190:460–6.

    Article  PubMed  Google Scholar 

  47. de Jonge P, Honig A, van Melle JP, et al. Nonresponse to treatment for depression following myocardial infarction: association with subsequent cardiac events. Am J Psychiatry. 2007;164(9):1371–8.

    Article  PubMed  Google Scholar 

  48. Glassman AH, O'Connor CM, Califf RM, et al. Sertraline treatment of major depression in patients with acute MI or unstable angina. JAMA. 2002;288(6):701–9.

    Article  PubMed  CAS  Google Scholar 

  49. Glassman AH, Bigger JT, Gaffney M. Psychiatric characteristics associated with long-term mortality among 361 patients having an acute coronary syndrome and major depression. Arch Gen Psychiatry. 2009;66(9):1022–1029.

    Article  PubMed  CAS  Google Scholar 

  50. Milani RV, Lavie CJ. Impact of cardiac rehabilitation on depression and its associated mortality. Am J Med. 2007;120(9):799–806.

    Article  PubMed  Google Scholar 

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Acknowledgments

This work was supported in part by grant no. 1R01HL08933601A2 from the National Heart, Lung, and Blood Institute, National Institutes of Health (Bethesda, MD), and support from the Lewis and Jean Sachs Charitable Lead Trust.

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No potential conflicts of interest relevant to this article were reported.

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Authors and Affiliations

  1. Behavioral Medicine Center, Department of Psychiatry, Washington University School of Medicine, 4320 Forest Park Avenue, Suite 301, St. Louis, MO, 63108, USA

    Robert M. Carney & Kenneth E. Freedland

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  1. Robert M. Carney
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  2. Kenneth E. Freedland
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Correspondence to Robert M. Carney.

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Carney, R.M., Freedland, K.E. Is There a High-Risk Subtype of Depression in Patients with Coronary Heart Disease?. Curr Psychiatry Rep 14, 1–7 (2012). https://doi.org/10.1007/s11920-011-0247-6

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  • DOI: https://doi.org/10.1007/s11920-011-0247-6

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