Therapie der Depression bei kardiometabolischen Erkrankungen

Zusammenfassung

In der klinischen Praxis findet sich bei der Depression häufig eine Assoziation mit bestimmten kardiometabolischen Erkrankungen. Teils führt diese Komorbidität zu einer negativen Verstärkung wie einer höheren Sterblichkeit nach Schlaganfall oder Myokardinfarkt. Pathophysiologisch bestehen verschiedene Verbindungen zwischen Depression und den assoziierten kardiometabolischen Erkrankungen. Dies bietet neben der Psychotherapie, die zur Behandlung der Depression eine tragende Rolle spielt, die Möglichkeit durch die Auswahl der medikamentösen Therapie neben der Depression parallel die assoziierte kardiometabolische Erkrankung positiv zu beeinflussen. Insgesamt lässt der Ausblick auf die Studienlage den Schluss zu, dass bei Komorbidität von Depression und Erkrankungen wie Diabetes mellitus Typ II, Myokardinfarkt und Schlaganfall, die Substanzklasse der SSRI durch teils synergistische Effekte einen Vorteil bei der Behandlung bietet, sofern spezifische Nebenwirkungen, wie beispielsweise die Verlängerung der QT-Zeit, den Einsatz nicht unmöglich machen.

Summary

In clinical practice depression is commonly associated with other cardiometabolic diseases. Partly this causes a negative impact like an increased mortality after stroke or myocardial infarction. Pathophysiologically there are different links between depression and the associated cardiometabolic disease. Next to psychotherapy, which plays an essential role in treating depression, this offers the opportunity to positively influence depression and the associated cardiometabolic disease in parallel with a single drug. With regard to the literature it seems that treating a patient with depression and a co morbid disease like diabetes type II, myocardial infarction or stroke SSRI provide an advantage by a positive, partly synergistic, impact on both diseases and can be recommended for treatment unless specific side effects like QT prolongation prevent their use.

Schlüsselwörter

Depression - Diabetes mellitus - Myokardinfarkt - Schlaganfall - Antidepressiva

Keywords

Depression - diabetes mellitus - myocardial infarction - stroke - antidepressants

• Literatur

• 1 Pan A. et al. Depression and risk of stroke morbidity and mortality. JAMA 2011; 306 (Suppl. 11) 1241-9.
• 2 Rozanski A. et al. The epidemiology, pathophysiology, and management of psychosocial risk factors in cardiac practice: the emerging field of behavioral cardiology. J Am Coll Cardiol 2005; 45: 637-51.
• 3 Dekker JM. et al. Metabolic syndrome and 10-year cardiovascular disease risk in the Hoorn Study. Circulation 2005; 112: 666-73.
• 4 Krauss RM. et al. AHA Dietary Guidelines: revision 2000: A statement for healthcare professionals from the Nutrition Committee of the American Heart Association. Circulation 2000; 102: 2284-99.
• 5 Knowler WC. et al. Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle Intervention or metformin. N Engl J Med 2002; 346: 393-403.
• 6 Dahlöf B. et al. Prevention of cardiovascular events with an antihypertensive regimen of amlodipine adding perindopril as required versus atenolol adding bendroflumethiazide as required, in the Anglo-Scandinavian Cardiac Outcomes Trial-Blood Pressure Lowering Arm (ASCOT-BPLA): a multicentre randomised controlled trial. Lancet 2005; 366 9489 895-906.
• 7 AVMS.. Leitlinien zur Behandlung der arteriellen Hypertonie, Deutsche Hochdruckliga e. V. DHL® – Deutsche Hypertonie Gesellschaft. Stand: 1. Juni Stuttgart 2008
• 8 Anderson RJ. et al. The prevalence of comorbid depression in adults with diabetes: a meta-analysis. Diabetes Care 2001; 24 (Suppl. 06) 1069-78.
• 9 Arroyo C. et al. Depressive symptoms and risk of type 2 diabetes in women. Diabetes Care 2004; 27 (Suppl. 01) 129-33.
• 10 Golden SH. et al. Depressive symptoms and the risk of type 2 diabetes: the Atherosclerosis Risk in Communities study. Diabetes Care 2004; 27 (Suppl. 02) 429-35.
• 11 Eaton WW. et al. Depression and risk for onset of type II diabetes. A prospective population-based study. Diabetes Care 1996; 19 (Suppl. 10) 1097-102.
• 12 Everson-Rose SA. et al. Depressive symptoms, insulin resistance, and risk of diabetes in women at mid-life. Diabetes Care 2004; 27 (Suppl. 12) 2856-62.
• 13 Mezuk B. et al. Depression and type 2 diabetes over the lifespan: a meta-analysis. Diabetes Care 2008; 31: 2383-90.
• 14 Schweiger U. et al. Disturbed glucose disposal in patients with major depression; application of the glucose clamp technique. Psychosom Med 2008; 70: 170-6.
• 15 Kahl KG. et al. Visceral fat deposition and insulin sensitivity in depressed women with and without comorbid borderline personality disorder. Psychosom Med 2005; 67: 407-12.
• 16 Thomsen SB. et al. Increased levels of the calcification marker matrix Gla protein and the inflammatory markers YKL-40 and CRP in patients with type 2 diabetes and ischemic heart disease. Cardiovasc Diab 2010; 9: 86.
• 17 Lustman PJ. et al. Cognitive behavior therapy for depression in type 2 diabetes mellitus. A randomized, controlled trial. Ann Intern Med 1998; 129 (Suppl. 08) 613-21.
• 18 Bschor T. et al. Impact of citalopram on the HPA system. A study of the combined DEX/CRH test in 30 unipolar depressed patients. J Psychiatr Res 2012; 46 (Suppl. 01) 111-7.
• 19 Benkert O, Hippius H. Kompendium der psychiatrischen Pharmakotherapie (8. Aufl.). Heidelberg: Springer; 2011
• 20 S3-Leitlinie/Nationale VersorgungsLeitlinie, Unipolare Depression Version 1.2, August 2011
• 21 Kennedy SH. et al. A double-blind comparison of sexual functioning, antidepressant efficacy, and tolerability between agomelatine and venlafaxine XR. J Clin Psychopharmacol 2008; 28 (Suppl. 03) 329-33.
• 22 Serretti A, Mandelli L. Antidepressants and body weight: a comprehensive review and meta-analysis. J Clin Psychiatry 2010; 71 (Suppl. 10) 1259-72.
• 23 Musselman DL, Evans DL, Nemeroff CB. The relationship of depression to cardiovascular disease: epidemiology, biology, and treatment. Arch Gen Psychiatry 1998; 55: 580-92.
• 24 Eaton WW, Fogel J, Armenian HK. The consequences of psychopathology in the Baltimore epidemiologic catchment area follow-up. In Eaton WW. editor. Medical and psychiatric comorbidity over the lifespan. Washington, DC: American Psychiatric Publishing, Inc.; 2006: 21-38.
• 25 Nicholson A, Kuper H, Hemingway H. Depression as an aetiologicand 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: 2763-74.
• 26 Halaris A. Comorbidity between depression and cardiovascular disease. International Angiology 2009; 28 (Suppl. 02) 92-9.
• 27 Wulsin LR, Singal BM. Do depressive symptoms increase the risk for the onset of coronary disease? A systematic quantitative review. Psychosom Med 2003; 65: 201-10.
• 28 Van der Kooy K. et al. Depression and the risk for cardiovascular diseases: systematic review and meta analysis. Int J Geriatr Psychiatry 2007; 22: 613-26.
• 29 Rugulies R. Depression as a predictor for coronary heart disease. A review and meta-analysis. Am J Prev Med 2002; 23: 51-61.
• 30 Aiyo AA. et al. Depressive symptoms and risks of coronary heart disease and mortality in elderly Americans. Cardiovascular Health Study Collaborative Research Group. Circulation 2000; 102 (Suppl. 15) 1773-9.
• 31 Van Melle JP. et al. Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: a meta-analysis. Psychosom Med 2004; 66: 814-22.
• 32 Otte C. et al. Depressive symptoms and 24-hour uri-nary norepinephrine excretion levels in patients with coronary disease: findings from the Heart and Soul Study. Am J Psychiatry 2005; 162: 2139-45.
• 33 Empana JP. et al. Contributions of depressive mood and circulating inflammatory markers to coronary heart disease in healthy European men: the Prospective Epidemiological Study of Myocardial Infarction (PRIME). Circulation 2005; 111: 2299-305.
• 34 Whalley B. et al. Psychological interventions for coronary heart disease. Cochrane Database Syst Rev 2011; (8): CD002902.
• 35 Ray WA. et al. Cyclic antidepressants and the risk of sudden cardiac death. Clin Pharmacol Ther 2004; 75: 234-41.
• 36 Pizzi C. et al. Meta-analysis of selective serotonin reuptake inhibitors in patients with depression and coronary heart disease. Am J Cardiol 2011; 107 (Suppl. 07) 972-9.
• 37 Dong JY. et al. Depression and Risk of Stroke: A Meta-Analysis of Prospective Studies. Stroke 2011 Oct 20, Epub ahead of print.
• 38 Huang CQ. et al. Chronic diseases and risk for depression in old age: a meta-analysis of published literature. Ageing Res Rev 2010; 9 (Suppl. 02) 131-41.
• 39 Hacke W. et al. Thrombolysis with alteplase 3 to 4.5 hours after acute ischemic stroke. N Engl J Med 2008; 359 (Suppl. 13) 1317-29.
• 40 Chollet F. et al. Fluoxetine for motor recovery after acute ischaemic stroke (FLAME): a randomised placebo-controlled trial. Lancet Neurol 2011; 10 (Suppl. 02) 123-30.
• 41 Boldrini M. et al. Antidepressants increase neural progenitor cells in the human hippocampus. Neuropsychopharmacology 2009; 34 (Suppl. 11) 2376-89.