Antidepressive Medikation bei Patienten mit kardiovaskulären Erkrankungen

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

• Literatur

• 1 Akselrod S, Gordon D, Ubel FA, Shannon DC, Barger AC, Cohen RJ. Power spectrum analysis of heart rate fluctuation: a quantitative probe of beat-to-beat cardiovascular control. Science 1981; 213: 220-2.
• 2 Amital D, Amital H, Gross R. Sinus bradycardia due to fluvoxamine overdose. Br J Psych 1994; 165: 553-4.
• 3 Appels A, Bar FW, Bar J, Bruggeman C, de Baets M. Inflammation, depressive symptomatology, and coronary artery disease. Psychosom Med 2000; 62: 601-5.
• 4 Barefoot JC, Helms MJ, Mark DB. et al. Depression and long-term mortality risk in patients with coronary artery disease. Am J Cardiol 1996; 78: 613-7.
• 5 Bigger jr JT, Giardina EG. Cardiac antiarrhythmic effect of imipramine hydrochloride. N Engl J Med 1977; 296: 206-8.
• 6 Blumenthal JA, Williams RS, Wallace AG, Williams RB, Needles TL. Physiological and psychological variables predict compliance to prescribed exercise therapy in patients recovering from myocardial infarction. Psychosom Med 1982; 44: 519-27.
• 7 Bottlender R, Dobmeier P, Moller HJ. The effect of selective serotonin-reuptake inhibitors in blood coagulation. Fortschr Neurol Psychiatrie 1998; 66: 32-5.
• 8 Breslau N, Peterson EL, Schultz LR, Chilcoat HD, Andreski P. Major depression and stages of smoking: A longitudinal investigation. Arch Gen Psychiatry 1998; 55: 161-6.
• 9 Buff DD, Brenner R, Kirtane S, Gilboua R. Dysrhythmia associated with fluoxetine treatment in an elderly patient with cardiac disease. J Clin Psychiatry 1991; 52: 174-5.
• 10 Carney RM, Freedland KE, Eisen SA, Rich MV, Jaffe AS. Major depression and medication adherence in elderly patients with coronary artery disease. Health Psychol 1995; 14: 88-90.
• 11 Carney RM, Freedland KE. Depression, mortality, and medical morbidity in patients with coronary heart disease. Biol Psychiatry 2003; 54: 241-7.
• 12 Carney RM, Saunders RD, Freedland KE, Stein P, Rich MW, Jaffe AS. Association of depression with reduced heart rate variability in coronary artery disease. Am J Cardiol 1995; 76: 562-4.
• 13 Carpenter KM, Hasin DS, Allison DB, Faith MS. Relationship between obesity and DSM-592/58 Meincke, HoffIV major depressive disorder, suicide ideation, and suicide attempts: Results from a general population study. Am J Public Health 2000; 90: 251-7.
• 14 Dalton SO, Johansen C, Mellemkjaer L, Norgard B, Sorensen HT, Ott JH. Use of selective serotonin in reuptake inhibitors and risk of upper gastrointestinal tract bleeding: a population-based cohort study. Arch Intern Med 2003; 163: 59-64.
• 15 Daly AK, King BP. Pharmacogenetics of oral anticoagulants. Pharmacogenetics 2003; 13: 247-52.
• 16 Drake WM, Gordon GD. Heart block in a patient on propanolol and fluoxetine. Lancet 1994; 343: 425-6.
• 17 Eaton WW, Armenian H, Gallo J, Pratt L, Ford DE. Depression and risk for onset of type II diabetes. A prospective population-based study. Diabetes care 1996; 19: 1097-102.
• 18 Feighner JP. Cardiovascular safety in depressed patients: Focus on venlafaxine. J Clin Psychiatry 1995; 56: 574-9.
• 19 Forrester AW, Lipsey JR, Teitelbaum ML, DePaulo JR, Andrzejewski PL, Robinson RG. Depression following myocardial infarction. Int J Psychiatry Med 1992; 22: 33-46.
• 20 Frasure-Smith N, Lesperance F, Talajic M. Depression following myocardial infarction impact on 6-month survival. JAMA 1993; 270: 1819-61.
• 21 Glassman AH, Bigger Jr JT, Giardina EG. Clinical characteristics of imipramine-induced orthostatic hypotension. Lancet 1979; 01: 468-72.
• 22 Glassman AH, Bigger JT. Cardiovascular effects of therapeutics doses of tricyclic antidepressants: A review. Arch Gen Psychiatry 1981; 38: 815-20.
• 23 Glassman AH, O’Connor CM, Califf RM. et al. Sertraline treatment of major depression in patients with acute MI or unstable angina. JAMA 2002; 288: 701-9.
• 24 Glassman AH, Rodriguez AI, Shapiro PA. The use of antidepressants drugs in patients with heart disease. J Clin Psychiatry 1998; 59 (Suppl. 10) 16-21.
• 25 Heard K, Cain BS, Dart RC, Cairns CB. Tricyclic antidepressants directly depress human myocardial mechanical function independent of effects on the conduction system. Acad Emerg Med 2001; 08: 1122-7.
• 26 Higham J, Kang JY, Majeed A. Recent trends in admissions and mortality due to peptic ulcer England: increasing frequency of haemorrhage among older subjects. Gut 2002; 50 (04) 460-4.
• 27 Kleiger RE, Miller PJ, Bigger TJ, Moss AJ. and the Multicenter Post-Infarction Research Group. Decreased heart-rate variability and its association with increased mortality after acute myocardial infarction. Am J Cardiol 1987; 59: 256-62.
• 28 Koenig W. Inflammation and coronary heart disease: An overview. Cardiol Rev 2001; 09: 31-5.
• 29 Kop WJ, Gottdiener JS, Tangen CM. et al. Inflammation and coagulation factors in persons > 65 years of age with symptoms of depression but without evidence of myocardial ischemia. Am J Cardiol 2002; 89: 419-24.
• 30 Laghrissi-Thode F, Wagner WR, Pollock BG, Johnson PC, Finkel MS. Elevated platelet factor 4 and ß-thromboglobulin plasma levels in depressed patients with ischemic heart disease. Biol Psychiatry 1997; 42: 290-5.
• 31 Layton D, Clark DW, Pearce GL, Shakir SA. Is there an association between selective serotonin reuptake inhibitors and risk of abnormal bleeding? Results from a coh study based on prescription event monitoring in England. Eur J Clin Pharmacol 2001; 57: 167-76.
• 32 Musselman DJ, Tomer A, Manatunga AK, Knight BT, Porter MR, Kasey S, Marzec U, Harler LA, Nemeroff CB. Exaggerated platelet reactivity in major depression. Am J Psychiatry 1996; 153: 1313-7.
• 33 Musselman DL, Evans DL, Nemeroff CB. The relationship of depression to cardiovascular disease. Arch Gen Psychiatry 1998; 55: 580-92.
• 34 Pollock BG, Laghrissi-Thode F, Wagner WR. Evaluation of platelet activation in depressed patients with ischemic heart disease after paroxetine or nortriptyline treatment. J Clin Psychopharmacol 2000; 20: 137-40.
• 35 Quattrocki E, Baird A, Yurgelun-Todd D. Biological aspects of the link between smoking and depression. Harv Rev Psychiatry 2000; 08: 99-110.
• 36 Rechlin T, Weis M, Claus D. Heart rate variability in depressed patients an differential effects of paroxetine and amitriptyline on cardiovascular autonomic functions. Pharmacopsychiatry 1994; 27: 124-8.
• 37 Roose SP, Glassman AH, Attia E, Woodring S, Giardina EG, Bigger Jr JT. Cardiovascular effects of fluoxetine in depressed patients with heart disease. Am J Psychiatry 1998; 155: 660-5.
• 38 Roose SP, Glassman AH, Dalack GW. Depression, heart disease and tricyclic antidepressants. J Clin Psychiatry 1989; 50 (Suppl. 07) 12-6.
• 39 Roose SP, Glassman AH. Antidepressant choice in the patient with cardiac disease: Lessons from the Cardiac Arrhythmia Suppression Trial (CAST) studies. J Clin Psychiatry 1994; 55 (Suppl.): 83-7.
• 40 Roose SP, Laghrissi-Thode F, Kennedy J, Nelson C, Bigger Jr JT, Pollock B, Gafney A, Narayan M, Finkel MS, Mc JCafferty, Gergel I. Comparison of paroxetine and nortriptyline in depressed patients with ischemic heart desease. JAMA 1998; 279: 287-91.
• 41 Roose SP, Laghrissi-Thode F, Kennedy JS. et al. A comparison of paroxetine to nortriptyline in depressed patients with IHD. JAMA 1997; 279: 287-91.
• 42 Roose SP. Treatment of depression in patients with heart disease. Biol Psychiatry 2003; 54: 262-8.
• 43 Sauer WH, Berlin JA, Kimmel SE. Selective serotonin reuptake inhibitors and myocardial infarction. Circulation 2001; 104: 1894-8.
• 44 Schleifer SJ, Macari-Hinson MM, Coyle DA, Slater WR, Kahn M, Gorlin R, Zucker HD. The nature and course of depression following myocardial infarction. Arch Intern Med 1989; 149: 1785-9.
• 45 Severus WS, Littmann AB, Stoll AL. Omega-3 fatty acids homocysteine, and the increased risk of cardiovascular mortality in major depressive disorder. Harv Rev Psychiatry 2001; 09: 280-93.
• 46 Shapiro PA, Lespérance F, Frasure-Smith N. et al. An open-label preliminary trial of sertraline for treatment of major depression after acute myocardial infarction (the SADHAT Trial). Sertraline Anti-Depressant Heart Attack Trial. Am Heart J 1999; 137: 1100-6.
• 47 Stern JJ, Pascale L, Ackermann A. Life adjustment post myocardial infarction: determine predictive variables. Arch Intern Med 1997; 137: 1680-5.
• 48 Veith RC, Lewis L, Linares OA, Barnes RF, Raskin MA, Villacres EC, Murburg MM, Ashleigh EA, Castillo S, Peskind ER, Pascualy M, Halter JB. Sympathetic nervous system activity in major depression: basal and desipramineinduced alterations in plasma norepinephrine kinetics. Arch Gen Psychiatry 1994; 51: 411-22.
• 49 Yeragani VK, Pesce V, Jayaraman A, Roose S. Major Depression with Ischemic Heart Disease: Effects of Paroxetine and Nortriptyline on Long-Term Heart Rate Variability Measures. Biol Psychiatry 2002; 52: 418-29.
• 50 Yeragani VK. Major depression and long-term heart period variability. Depress Anxiety 2000; 12: 51-2.