cardiovascular-agents and Depressive-Disorder--Major

Major depressive disorder (MDD) and anxiety disorders (AD) are both highly prevalent among individuals with arrhythmia, ischemic heart disease, heart failure, hypertension, and dyslipidemia. There should be increased support for MDD and AD diagnosis and treatment in individuals with cardiac diseases, because treatment rates have been low. However, cardiac-psychiatric drug interaction can make pharmacologic treatment challenging.. The objective of the present systematic review was to investigate cardiac-psychiatric drug interactions in three different widely used pharmacological databases (Micromedex, Up to Date, and ClinicalKey).. Among 4914 cardiac-psychiatric drug combinations, 293 significant interactions were found (6.0%). When a problematic interaction is detected, it may be easier to find an alternative cardiac medication (32.6% presented some interaction) than a psychiatric one (76.9%). Antiarrhythmics are the major class of concern. The most common problems produced by these interactions are related to cardiotoxicity (QT prolongation, torsades de pointes, cardiac arrest), increased exposure of cytochrome P450 2D6 (CYP2D6) substrates, or reduced renal clearance of organic cation transporter 2 (OCT2) substrates and include hypertensive crisis, increased risk of bleeding, myopathy, and/or rhabdomyolysis.. Unfortunately, there is considerable inconsistency among the databases searched, such that a clinician's discretion and clinical experience remain invaluable tools for the management of patients with comorbidities present in psychiatric and cardiac disorders. The possibility of an interaction should be considered. With a multidisciplinary approach, particularly involving a pharmacist, the prescriber should be alerted to the possibility of an interaction. MDD and AD pharmacologic treatment in cardiac patients could be implemented safely both by cardiologists and psychiatrists.. PROSPERO Systematic Review Registration Number: CRD42018100424.

Topics: Antipsychotic Agents; Cardiovascular Agents; Cardiovascular Diseases; Cytochrome P-450 CYP2D6; Databases, Pharmaceutical; Depressive Disorder, Major; Drug Interactions; Humans; Metabolic Clearance Rate; Organic Cation Transporter 2

Evidence from previous studies suggests that heart rate variability (HRV) is reduced in major depressive disorder (MDD). However, whether this reduction is attributable to the disorder per se or to medication, since antidepressants may also affect HRV, is still debated. There is a dearth of information regarding the effects of agomelatine, a novel antidepressant, on HRV. Here, we investigated whether HRV is reduced in MDD and compared the effects of agomelatine and paroxetine on HRV. We recruited 618 physically healthy unmedicated patients with MDD and 506 healthy volunteers aged 20-65 years. Frequency-domain measures of resting HRV were obtained at the time of enrollment for all participants. For patients with MDD, these measures were obtained again after 6 weeks of either agomelatine or paroxetine monotherapy. Compared with healthy subjects, unmedicated patients with MDD exhibited significantly lower variance (total HRV), low frequency (LF), and high frequency (HF) HRV, and a higher LF/HF ratio. Depression severity independently contributed to decreased HRV and vagal tone. Fifty-six patients completed the open-label trial (n=29 for agomelatine, n=27 for paroxetine). Between-group analyses showed a significant group-by-time interaction for LF-HRV and HF-HRV, driven by increases in LF-HRV and HF-HRV only after agomelatine treatment. Within the paroxetine-treated group, there were no significant changes in mean R-R intervals or any HRV indices. We therefore concluded that MDD is associated with reduced HRV, which is inversely related to depression severity. Compared with paroxetine, agomelatine has a more vagotonic effect, suggesting greater cardiovascular safety. Clinicians should consider HRV effects while selecting antidepressants especially for depressed patients who already have decreased cardiac vagal tone.

Topics: Acetamides; Adult; Aged; Antidepressive Agents; Blood Pressure; Cardiovascular Agents; Case-Control Studies; Depressive Disorder, Major; Female; Heart Rate; Humans; Male; Middle Aged; Paroxetine; Psychiatric Status Rating Scales; Regression Analysis; Rest; Severity of Illness Index; Taiwan; Young Adult

Topics: Abortion, Induced; Adult; Cardiovascular Agents; Depressive Disorder, Major; Electrocardiography; Female; Humans; Pregnancy; Takotsubo Cardiomyopathy; Treatment Outcome

The aim of our research was retrospective analysis of poisoning with cardiovascular drugs (T46 according to ICD 10 classification) in patients over 59 years old, hospitalized in Province Poisoning Centre in Lublin, in the period from 1995 to 2001. There were hospitalized 288 patients at this time age, over 59 years old. Among this 16 persons were poisoned with cardiovascular drugs (one accidental and 15 suicidal intoxications), and 3 of them died. Different kinds of cardiovascular medications were used e.g. digoxin, nitrates, hypotensive drugs (as single and multiplied drug poisonings). At 3 of the patients depression was diagnosed.

Topics: Aged; Aged, 80 and over; Cardiovascular Agents; Cardiovascular Diseases; Catchment Area, Health; Depressive Disorder, Major; Female; Hospitalization; Humans; Male; Middle Aged; Poison Control Centers; Poisoning; Poland; Retrospective Studies