Co-occurrence of depressive disorders and cardiovascular diseases – selected aspects

Abstract

Depressive disorders are a common problem in patients with cardiovascular diseases. They are associated with increased mortality, disability, increased healthcare expenditure and reduced quality of life. Depression occurs in 1 in 5 patients with coronary artery disease, peripheral arterial disease or heart failure. It significantly complicates the optimal management of a patient with cardiovascular disease, primarily by reducing compliance with healthy lifestyle principles and therefore reducing the effectiveness of recommended therapeutic methods. The mechanisms responsible for unfavorable prognosis in patients with cardiovascular disease and depression are associated with lifestyle factors, autonomic dysfunction, neuroendocrine disorders, inflammation, immune system dysfunction, insulin resistance and increased platelet reactivity. These mechanisms significantly interact in the regulation of both cardiovascular and central nervous system functions. Therefore, it is important to perform prompt and complete diagnosis of depression in a particular patient with cardiovascular disease, and to implement optimal therapeutic management from the psychiatric and cardiological point of view. In recent years, interest in the effect of antidepressants on cardiac parameters in patients with depression has increased. The assessment of the safety and efficacy of antidepressant therapy in the treatment of cardiac patients with depression is also important due to the fact that depression in these patients is often accompanied by other significant comorbidities such as diabetes, hypertension and tobacco addiction. The aim of this study was to review the most important aspects necessary in the cooperation of a psychiatrist and cardiologist that may enable the most effective treatment of patients with depressive disorders coexisting with selected cardiovascular diseases.