There is a definite correlation between cardiovascular diseases and depressive disorders. Nevertheless, many aspects of this association have yet to be fully elucidated. Up to half of coronary artery disease patients are liable to suffer from some depressive symptoms, with approximately 20% receiving a diagnosis of major depressive disorders. Pharmacotherapy is a key faktor in the management of major depression, not least in patients with chronic diseases who are likely to fail to show proper compliance and response to non-pharmacological interventions. Antidepressants are not deemed completely safe. Indeed, numerous side effects have been reported with the administration of antidepressants, among which cardiovascular adverse events are of paramount importance owing to their disabling and life-threatening nature. We aimed to re-examine some of the salient issues in antidepressant therapy vis-à-vis cardiovascular considerations, which should be taken into akun when prescribing such medications.
Keywords: Cardiovascular diseases; Antidepressive agents; Depressive disorder, major
Introduction
A definite correlation exists between cardiovascular diseases (CVD) and depressive disorders, yet many aspects of this relationship have remained challenging. Up to 50% of patients with coronary artery disease (CAD) suffer from some depressive symptoms and approximately 20% of them have a diagnosis of major depressive disorder (MDD). On the other hand, it has been demonstrated that depressed patients are more vulnerable to experience myocardial infarction even after controlling their pure cardiovascular risk factors. Moreover, significantly higher risk of mortality due to cardiovascular events has been reported in patients suffering from psychiatric disorders such as depression. The diagnosis of depression can be difficult in people with CVD as depressive symptoms such as fatigue and low energy are common in people with CVD and may also be a side effect of some drugs used to treat CVD such as beta blockers. The diagnosis may be further complicated in such patients by their responses to their disease, which may include denial, avoidance, withdrawal, and anxiety.
According to the World Health Organization (WHO) reports, ischemic heart disease is now the leading cause of death worldwide and by 2030, depression will have the greatest burden among diseases in terms of years lost due to disability. Besides impairing patients’ quality of life, depression has profound negative effects on the long-term prognosis of individuals with any style of cardiovascular disorder. These facts further underscore the importance of the proper treatment of depression in patients with CVD.