Antidepressive Medikation bei Patienten mit kardiovaskulären Erkrankungen

U. Meincke; P. Hoff

doi:10.1055/s-0038-1626423

Nervenheilkunde, Table of Contents

Nervenheilkunde 2004; 23(10): 588-592
DOI: 10.1055/s-0038-1626423

Original- und Übersichtsarbeiten - Original and Review Articles

Schattauer GmbH

Antidepressive Medikation bei Patienten mit kardiovaskulären Erkrankungen

Antidepressants in patients with cardiovascular disease

U. Meincke

¹Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum der RWTH Aachen

,

P. Hoff

²Psychiatrische Universitätsklinik Zürich

› Author Affiliations

Abstract

Zusammenfassung

Infolge der demographischen Entwicklung wird die Komorbidität von depressiven Störungen mit kardiovaskulären Erkrankungen zunehmend an Bedeutung gewinnen. Dies liegt zum einen an der hohen Prävalenz dieser Volkskrankheiten bei älteren Patienten, zum anderen ist es gut belegt, dass depressive Syndrome mit einem zwei- bis vierfach erhöhten Morbiditäts- und Mortalitätsrisiko für kardiovaskuläre Erkrankungen verbunden sind. Bislang liegen nur wenige kontrollierte Studien vor, die eine gute Wirksamkeit von Nortriptylin als trizyklisches Antidepressivum (TZA) sowie von den Serotonin-Rückaufnahmehemmern (SSRI) Paroxetin und Sertralin bei depressiven Patienten mit kardialen Erkrankungen belegen. Aufgrund des kardiovaskulären Nebenwirkungsprofils der TZA (z.B. arterielle Hypotonie, AV-Block, QT-Verlängerung, Verminderung der Frequenzvariabilität) sind SSRI als Medikamente der ersten Wahl in der Behandlung depressiver Episoden bei Patienten mit koronaren Herzkrankheiten (KHK) anzusehen. Zudem ergaben sich erste Hinweise, dass SSRI möglicherweise den Langzeitverlauf koronarer Herzerkrankungen durch Verminderung der Thrombozytenaggregationsneigung günstig beeinflussen können. Auf der anderen Seite zeigen epidemiologische Studien, dass eine langfristige Therapie mit SSRI mit einem erhöhten Risiko für hämorrhagische Komplikationen verbunden ist. Zudem ist im klinischen Alltag auch die Kenntnis des Interaktionsprofils einzelner SSRI mit kardiovaskulär relevanten Medikamenten (z.B. Cumarin-Derivate, Kalzium-Antagonisten, ß-Blocker, Amiodaron) von großer Bedeutung, um die Behandlung depressiver Störungen bei herzkranken Patienten zu optimieren.

Summary

As a result of demographic development the comorbidity of affective disorder and cardiovascular disease will get more important in the future. This assumption is based on the high prevalence of both depressive episodes and cardiovascular disease in elderly patients. In addition, it is known that depression is associated with a twofold to fourfold risk of morbidity and mortality for cardiovascular disease.

As of yet, there are only few studies demonstrating therapeutic efficacy of the tricyclic antidepressant nortriptyline as well as of serotonin-reuptake-inhibitors, like paroxetine and sertraline, in depressive patients with concomitant coronary heart disease. Due to side effects on cardial functions of tricyclic agents (e.g. orthostatic hypotension, atrioventricular block, QT-prolongation, reduction of heart rate variability) SSRI are suitable to be recommended as agents of first choice. Moreover, it has been shown that SSRI might be valuable to improve long-term outcome in coronary heart disease by reduction of platelet aggregation. On the other side, epidemiological studies suggest an increased risk of haemorrhagic complications in long-term treatment with SSRI. Besides, for clinicians the knowledge of interactions of SSRI with medications relevant for treating cardiovascular disease (e.g. coumarine-derivates, calcium-antagonists, ß-blocker, amiodarone) is crucial to optimize antidepressant treatment in patients with cardiovascular disease.

Schlüsselwörter

Antidepressiva - Depression - kardiovaskuläre Erkrankungen - koronare Herzkrankheit

Keywords

Antidepressants - depression - cardiovascular disease - coronary heart disease

Full Text

References

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