Biological mechanisms in the relationship between depression and heart disease

doi:10.1016/S0149-7634(03)00003-4

Neuroscience & Biobehavioral Reviews

Volume 26, Issue 8, December 2002, Pages 941-962

https://doi.org/10.1016/S0149-7634(03)00003-4 Get rights and content

Abstract

Psychological depression is shown to be associated with several aspects of coronary artery disease (CAD), including arrhythmias, myocardial infarction, heart failure and sudden death. The physiological mechanisms accounting for this association are unclear. Hypothalamic–pituitary–adrenal dysregulation, diminished heart rate variability, altered blood platelet function and noncompliance with medial treatments have been proposed as mechanisms underlying depression and cardiovascular disease. Recent evidence also suggests that reduced baroreflex sensitivity, impaired immune function, chronic fatigue and the co-morbidity of depression and anxiety may be involved in the relationship between depression and cardiovascular dysregulation. An experimental strategy using animal models for investigating underlying physiological abnormalities in depression is presented. A key to understanding the bidirectional association between depression and heart disease is to determine whether there are common changes in brain systems that are associated with these conditions. Such approaches may hold promise for advancing our understanding of the interaction between this mood disorder and CAD.

Section snippets

Depression and cardiovascular disease

Several studies, including both cross-sectional and prospective analyses, have demonstrated an extensive co-morbidity of depression and cardiovascular disease [7], [13], [18], [19], [44], [83], [89]. Converging evidence (reviewed later) suggests that depression is an important cardiovascular risk factor both in medically healthy individuals and cardiac patients, and conversely, the presence of cardiovascular disease can influence mood states. Similar to cardiovascular diseases, the prevalence

A strategy for the mechanistic analysis of the association between depression and heart disease

A clear association exists between depression and cardiovascular dysregulation. The challenge lies in mechanistically accounting for this relationship. Depression may perhaps be conceptualized to influence cardiovascular function via neuroimmunomodulatory autonomic dysregulation. Fig. 4 presents an integrative pathophysiologic model of the important pathways that may influence the association between depression and cardiovascular regulation. Autonomic function is altered in depression,

Final comments

Cardiovascular disease claims 12 million lives per year worldwide [5]. It is the leading cause of death for both males and females, accounting for approximately 50% of all deaths in developed and developing countries. Over 59 million Americans currently have one or more forms of cardiovascular disease and 900,000 will die from the disease this year [5]. According to recent estimates, approximately 75,000 deaths per year in the United States among patients discharged after an initial myocardial

Acknowledgments

We would like to thank Dr Greta Sokoloff, Dr Erin Whalen and Mr Kevin Wu for their helpful comments. The research discussed in the concluding sections of this article was performed in collaboration with Mr Terry Beltz, Dr Robert Felder, Dr Joseph Francis, Dr Ralph Johnson, Dr James Martins, Dr Julia Moffitt, Dr Claudia Santos and Dr Robert Weiss at the University of Iowa. We are grateful to Mr Lloyd Frei, Mr Keith Miller and Mr Brian Wulff for their technical assistance. These projects were

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Citation Excerpt :
Parasympathetic predominance was also reported in patients with subsyndromal seasonal affective disorder (Austen and Wilson, 2001). In contrast, studies focused on clinical patients with MDD highlighted different results, showing lower parasympathetic and higher sympathetic activity in depressed patients (Brown et al., 2018; Bär et al., 2004; Udupa et al., 2007), associated with a dysfunction of the hypothalamo-pituitary axis, marked by an increased secretion of cortisol, adrenalin and noradrenalin (Grippo and Johnson, 2002). We did not observe HF-HRV alterations in the groups of depressed women.
Cross-sectional studies highlighted changes in autonomic nervous system (ANS) activity in geriatric depression. However, few longitudinal studies assessed this link which remains still debated. We examined the longitudinal association between lifetime depression history, current depressive disorders, and the evolution of ANS activity in older community women.
The present data stemmed from the PROOF study, a population-based cohort of 1011 community-dwellers followed-up at 2-year intervals for 10 years. Only data from female participants was analyzed (n = 508, mean age 68.5 ± 0.88 years), as very few men had depression in our population. Depressive symptoms and depression history were collected at baseline. Participants were classified in four groups according to presence or absence of history of depression (HD) or current depressive symptomatology (CD): HD+/CD+, HD−/CD+, HD+/CD− and HD−/CD−. ANS activity was assessed during the follow-up through 24-h heart rate variability (HRV). Longitudinal associations between depressive status and HRV indices during the follow-up were investigated using multivariate linear mixed models.
Compared to HD−/CD− group, women belonging to HD−/CD+ group had greater baseline parasympathetic tone, as measured by lower LF index and LF/HF balance. The longitudinal analysis exhibited a significant enhancement of LF/HF balance with time, measuring an increase of sympathetic tone in HD−/CD+ group.
Our findings suggest that late-onset depressive symptoms may be associated with subsequent autonomic dysregulation in older women. These results highlight the importance of detecting and managing depressive symptoms to limit their consequences on ANS functioning, and the risk of cardiovascular events.
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ReviewBiological mechanisms in the relationship between depression and heart disease

Abstract

Section snippets

Depression and cardiovascular disease

A strategy for the mechanistic analysis of the association between depression and heart disease

Final comments

Acknowledgments

J Affect Disord

Pharmacol Ther

Psychoneuroendocrinology

Eur Neuropsychopharmacol

Am J Cardiol

Life Sci

Am J Cardiol

Am J Cardiol

Immunol Today

Neurosci Biobehav Rev

Gen Hosp Psychiatry

Microvasc Res

Am J Med

J Psychosom Res

Am J Cardiol

Am J Cardiol

Life Sci

Lancet

Pharmacol Biochem Behav

Am J Cardiol

Comp Psychiatry

Biol Psychiatry

Biol Psychiatry

J Am Coll Cardiol

Prostaglandins Leukot Essent Fatty Acids

Am Heart J

Psychosomatics

Neuropeptides

Metabolic rate in the right amygdala predicts negative affect in depressed patients

NeuroReport

Chronic stress increases serotonin and noradrenaline in rat brain and sensitizes their responses to a further acute stress

J Neurochem

Autonomic mechanisms and sudden death after abrupt coronary occlusion

Ann Med

2002 heart and stroke statistical update (Online)

Diagnostic and statistical manual of mental disorders

Depressed affect, hopelessness, and the risk of ischemic heart disease in a cohort of U.S. adults

Epidemiology

Depression: the predisposing influence of stress

Behav Brain Sci

Depression as a consequence of inadequate neurochemical adaptation in response to stressors

Br J Psychiatry

Excess fatigue as a precursor of myocardial infarction

Eur Heart J

Nervous system–immune system communication

Rev Infect Dis

Depression and cardiovascular diseases

Acta Psychiatr Scand

Tumor necrosis factor alpha and the cardiovascular system: its role in cardiac allograft rejection and heart disease

Cardiovasc Res

Increases in heart rate variability with successful treatment in patients with major depressive disorder

Psychopharmacol Bull

Symptoms of depression, acute myocardial infarction, and total mortality in a community sample

Circulation

An inventory for measuring depression

Arch Gen Psychiatr

Role of cardiovascular reactivity to mental stress in predicting future hypertension

Clin Exp Hypertens

Retarding effect of lowered heart rate on coronary atherosclerosis

Science

Principles of the pharmacotherapy of depression

Stress factors in affective diseases

Br J Psychiatry

Baroreceptor reflex control of heart rate: a predictor of sudden cardiac death

Circulation

Psychological predictors of heart disease: a quantitative review

Psychol Bull

The role of macrophages in atherosclerosis

Review
Biological mechanisms in the relationship between depression and heart disease