cardiovascular-agents and Depressive-Disorder

Although medications such as anticancer, antimicrobial, immunomodulatory, neurological or hormonal therapies may have a negative impact on mood, adequate attention was not paid until the withdrawal of rimonabant in 2008. In the present study the authors review full spectrum of currently available medications discussing anxiety and depression as possible adverse effects of treatment. A relatively high risk of depression should always be considered when pharmacotherapy applied, especially if current depressive episodes, positive family history, or neurotic personality traits increasing susceptibility to depressogenic effects. Prior to start of medical treatment, the potential effectiveness of the given drug should be precisely evaluated, and alternative medical and non-medical treatment options should also be carefully considered. In addition, monitoring patients during treatment for signs of depressive or anxious symptoms is necessary.. Annak ellenére, hogy számos szomatikus betegség kezelésére alkalmazott – például daganatellenes, antimikrobás, immunmoduláns, neurológiai, illetve hormonháztartásra ható – gyógyszer hathat negatív irányban a hangulatra, ezt egészen a rimonabant 2008-ban emiatt történt visszavonásáig nem kezelték jelentőségének megfelelően. A szerzők a teljes gyógyszerpalettát áttekintve tárgyalják a szorongást és a depressziót, mint gyógyszer-mellékhatásokat. A gyógyszerválasztásnál minden esetben figyelembe kell venni, ha a betegeknél magas a depresszió kialakulásának a kockázata, például, ha már korábban előfordult vagy jelenleg is fennáll a depressziós epizód vagy betegség, ha a családi anamnézisben előfordul depresszió, illetve ha a betegnél olyan neurotikus személyiségvonások állnak fenn, amelyek következtében sérülékenyebb a depressziót kiváltó hatásokkal szemben. A veszélyt jelentő gyógyszerek felírása előtt emellett célszerű figyelembe venni az alkalmazni kívánt szer hatékonyságát, a rendelkezésre álló alternatív gyógyszeres és nem gyógyszeres terápiás lehetőségeket, és minden esetben biztosítani kell a beteg monitorozását a kezelés során az esetleges depressziós vagy szorongásos tünetek mihamarabbi észlelése érdekében. Orv. Hetil., 2013, 154, 1327–1336.

Topics: Analgesics, Non-Narcotic; Anti-Infective Agents; Anti-Obesity Agents; Anticonvulsants; Antineoplastic Agents; Antiparkinson Agents; Anxiety; Anxiety Disorders; Cardiovascular Agents; Central Nervous System Agents; Depression; Depressive Disorder; Dermatologic Agents; Fertility Agents, Female; Humans; Immunologic Factors; Interferon-beta; Precision Medicine

At least 1 in 7 cardiology patients now reports nonadherence to prescribed medications, potentially leading to negative outcomes across a broad range of cardiovascular diseases. This nonadherence can begin as early as the time of prescription or any time thereafter and occurs for a variety of reasons, including communication difficulties, polypharmacy, and a variety of objective and perceived side-effects. Among elderly, low-income, and disabled patients, drug costs represent a growing source of medication nonadherence and can be markedly reduced through the use of drug assistance programs and low-cost generic medications without sacrificing evidence-based therapy. Depression also contributes strongly to nonadherence and is widely prevalent in cardiovascular populations. Improvements in depression are mirrored by improvements in adherence. A systematic screening to identify the presence of nonadherence and many of its causes can be accomplished with minimal impact on visit length. In conclusion, once specific concerns are recognized, options frequently exist to help patients and providers address many of the most common difficulties.

Topics: Age Factors; Cardiovascular Agents; Cardiovascular Diseases; Depressive Disorder; Drug Prescriptions; Evidence-Based Medicine; Female; Humans; Male; Needs Assessment; Patient Compliance; Patient Education as Topic; Risk Assessment; Socioeconomic Factors; United States

Topics: Antidepressive Agents; Arrhythmias, Cardiac; Cardiovascular Agents; Depressive Disorder; Heart Diseases; Humans; Monoamine Oxidase Inhibitors; Prospective Studies; Risk Factors

To study the therapeutic efficacy and safety of Ginkgo special extract EGb 761 in the treatment of cognitive and non-cognitive symptoms (anxiety, depression, sleep disorders, activity) in patients with discirculatory encephalopathy (DE) and cognitive impairment.. The study enrolled 45 patients with DE (mean age 60,8±5,9 years). Patients were randomized to treatment with EGb 761 (30 patients) or other drugs (15 patients). Patients underwent neurological examinations, along with cognitive and neuropsychological testing (FAB, MMSE, HADS and other tests). EGb 761 was used in dose 240 mg per day during 24 weeks.. By the end of the study, the levels of anxiety and depression decreased (p<0,05) to the 12th and 24th week, respectively.. The results indicate the efficacy and good tolerability of EGb 761 in the treatment of mental disorders in DE patients with cognitive impairment. The best effect was observed in relation to anxiety.

Topics: Aged; Anxiety Disorders; Cardiovascular Agents; Cerebrovascular Disorders; Cognition Disorders; Depressive Disorder; Female; Ginkgo biloba; Humans; Male; Middle Aged; Plant Extracts; Treatment Outcome

Non-cardiac chest pain (NCCP) is an extremely debilitating condition of uncertain origin which is difficult to treat and consequently has a high psychological morbidity. Hypnotherapy has been shown to be effective in related conditions such as irritable bowel syndrome where its beneficial effects are long lasting.. This study aimed to assess the efficacy of hypnotherapy in a selected group of patients with angina-like chest pain in whom coronary angiography was normal and oesophageal reflux was not contributory.. Twenty eight patients fulfilling the entry criteria were randomised to receive, after a four week baseline period, either 12 sessions of hypnotherapy or supportive therapy plus placebo medication over a 17 week period. The primary outcome measure was global assessment of chest pain improvement. Secondary variables were a change in scores for quality of life, pain severity, pain frequency, anxiety, and depression, as well as any alteration in the use of medication.. Twelve of 15 (80%) hypnotherapy patients compared with three of 13 (23%) controls experienced a global improvement in pain (p = 0.008) which was associated with a significantly greater reduction in pain intensity (p = 0.046) although not frequency. Hypnotherapy also resulted in a significantly greater improvement in overall well being in addition to a reduction in medication usage. There were no differences favouring hypnotherapy with respect to anxiety or depression scores.. Hypnotherapy appears to have use in this highly selected group of NCCP patients and warrants further assessment in the broader context of this disorder.

Topics: Anxiety; Cardiovascular Agents; Chest Pain; Depressive Disorder; Female; Gastroesophageal Reflux; Humans; Hypnosis; Male; Middle Aged; Proton Pump Inhibitors; Quality of Life; Single-Blind Method; Treatment Outcome

Sexual quality of life is important for many individuals; therefore, this study examined the frequency of depression in a younger and middle-aged population-based sample, and the impact on physical activity, quality of life, and sexual activity, and the role of antidepressant and cardiac drugs on sexual function. The sample, ages 20 to 59 years, completed relevant items for depression, sexual activity, physical activity, quality of life, and drugs. Data were analyzed using descriptive statistics, Pearson correlations, t-tests, and analysis of variance. Those sexually active had lower mean depression scores and higher ratings of quality of life, while those sexually inactive had greater depression and took more drugs. Thorough assessment of drugs, depression, cardiac and other medical conditions, and interest and engagement in sexual activity should be routinely assessed in all patients, regardless of age.

Topics: Adult; Antidepressive Agents; Cardiovascular Agents; Depressive Disorder; Exercise; Female; Humans; Male; Middle Aged; Quality of Life; Sexual Behavior; Young Adult

This study determined temporal stability of ambulatory measured cardiac autonomic activity for different time periods and investigated potential drivers of changes in this activity.. Data was drawn from baseline (n=2379), 2-year (n=2245), and 6-year (n=1876) follow-up from the Netherlands Study of Depression and Anxiety. Cardiac autonomic activity was measured with heart rate (HR), respiratory sinus arrhythmia (RSA) and pre-ejection period (PEP). Autonomic temporal stability was determined across 2, 4, and 6year intervals. We subsequently examined the association between sociodemographics, lifestyle, mental health, cardiometabolic health, and the use of antidepressant and cardiac medication with change in cardiac autonomic activity.. Over 2years, stability was good for HR (ICC=0.703), excellent for RSA (ICC=0.792) and moderate for PEP (ICC=0.576). Stability decreased for a 4- (HR ICC=0.688, RSA ICC=0.652 and PEP ICC=0.387) and 6-year interval (HR ICC=0.633, RSA ICC=0.654 and PEP ICC=0.355). The most important determinants for increase in HR were (increase in) smoking, increase in body mass index (BMI) and (starting) the use of antidepressants. Beta-blocking/antiarrhythmic drug use led to a decrease in HR. Decrease in RSA was associated with age, smoking and (starting) antidepressant use. Decrease in PEP was associated with age and (increase in) BMI.. Cardiac autonomic measures were rather stable over 2years, but stability decreased with increasing time span. Determinants contributing to cardiac autonomic deterioration were older age, (increase in) smoking and BMI, and (starting) the use of antidepressants. (Starting) the use of cardiac medication improved autonomic function.

Topics: Adolescent; Adult; Aged; Antidepressive Agents; Anxiety Disorders; Autonomic Nervous System; Body Mass Index; Cardiovascular Agents; Depressive Disorder; Female; Follow-Up Studies; Heart; Heart Rate; Humans; Longitudinal Studies; Male; Middle Aged; Netherlands; Respiratory Sinus Arrhythmia; Smoking; Socioeconomic Factors; Time Factors; Young Adult

Medication non-adherence is common and a primary reason for poor medical outcomes among individuals with heart failure (HF). This study's aims were to determine whether depression, hostility, and the personality-based Millon Behavioral Medicine Diagnostic (MBMD) Medication Abuse scale were associated with medication adherence (e.g., beta-blockers, ACE inhibitors, diuretics, statins) beyond contributions of demographic, medical, and psychosocial variables in an ethnically-diverse sample of 105 men and women diagnosed with HF. In hierarchical regression, greater MBMD Medication Abuse scale scores were associated with poorer adherence above and beyond both depression (β = .236, t[102] = 2.113, p = .037) and hostility (β = .244, t[102] = 2.506, p = .014). The Medication Abuse scale also completely mediated the relationship between adherence and depression. These findings suggest that personality measures such as the MBMD and hostility scales might be utilized in future studies investigating predictors of adherence and also used clinically to predict medication adherence among HF patients.

Topics: Aged; Cardiovascular Agents; Comorbidity; Cross-Sectional Studies; Depressive Disorder; Female; Heart Failure; Hostility; Humans; Male; Medication Adherence; Middle Aged; Personality Inventory; Psychometrics; Regression Analysis; Reproducibility of Results; Statistics as Topic; Substance-Related Disorders; Treatment Outcome

Topics: Anti-Obesity Agents; Cardiovascular Agents; Cardiovascular Diseases; Depressive Disorder; Drug Approval; Europe; Humans; Multicenter Studies as Topic; Piperidines; Pyrazoles; Randomized Controlled Trials as Topic; Rimonabant; Suicide; Treatment Failure

Topics: Anti-Obesity Agents; Cardiovascular Agents; Cardiovascular Diseases; Cytochrome P-450 CYP2D6; Depressive Disorder; Europe; Humans; Multicenter Studies as Topic; Piperidines; Pyrazoles; Randomized Controlled Trials as Topic; Research Design; Rimonabant; Suicide; Treatment Failure

Patients with unrepaired abdominal aortic aneurysm (AAA) may have depression and other psychiatric disorders for which electroconvulsive therapy (ECT) may be recommended. It is unclear whether ECT, which transiently, yet markedly, increases blood pressure and heart rate, can be safely performed in patients with AAA. We investigated the safety of ECT in patients with unrepaired AAA.. A retrospective review was conducted of the medical records of all patients with unrepaired AAA who underwent ECT for severe depressive syndromes at Mayo Clinic, Rochester, Minn, between January 1, 1995, and June 30, 2007.. Eight patients (5 men and 3 women) with unrepaired AAA who underwent ECT were identified. Median age was 78.5 years (range, 67-83 years). All patients had AAA (median diameter, 3.95 cm [range, 3.0-5.2 cm]). The median number of treatments was 8.5 (range, 4-48). None of the patients died during the periprocedural period or experienced symptoms or signs suggestive of AAA expansion or rupture. Follow-up imaging data were available for 6 patients whose median post-ECT AAA diameter was 4.65 cm (range, 3.3-5.3 cm). Expansion of AAA ranged from 0.1 cm (for 11 and 13 months in 2 patients) to 1.0 cm (for 29 months in 1 patient), which is less than the expected mean expansion rates for AAAs of these diameters.. Electroconvulsive therapy was safe for 8 patients with unrepaired AAA treated at our institution. Our findings may be informative to clinicians who manage the care of patients with unrepaired AAA who are undergoing ECT.

Topics: Aged; Aged, 80 and over; Anesthesia; Aortic Aneurysm, Abdominal; Blood Pressure; Cardiovascular Agents; Depressive Disorder; Electroconvulsive Therapy; Female; Heart Rate; Humans; Male; Retrospective Studies; Safety; Seizures

Topics: Antidepressive Agents; Arrhythmias, Cardiac; Autonomic Nervous System; Cardiovascular Agents; Depressive Disorder; Drug Interactions; Heart Diseases; Humans

Some reports have suggested that calcium channel blockers may be associated with an increased incidence of depression or suicide. There is a paucity of evidence from large scale studies. The aim of this study was to assess rates of depression with calcium channel antagonists using data from prescription event monitoring studies.. Observational studies on large cohorts of patients using lisinopril, enalapril (ACE inhibitors), nicardipine (type 2 calcium channel blocker) and diltiazem (type 3 calcium channel blocker) were conducted, using prescription-event monitoring. Rates of depression in the different drugs and rate ratios (95% CI) were computed.. The crude overall rates of depression during treatment were 1.89, 1.92 and 1.62 per 1000 patient months for the ACE inhibitors, diltiazem and nicardipine, respectively. Using the ACE inhibitors as the reference group, the rate ratios for depression were 1.07 (0. 82-1.40) and 0.86 (0.69-1.08) for diltiazem and nicardipine, respectively.. This study does not support the hypothesis that calcium channel blockers are associated with depression, when considering patients treated in general practice in the UK.

Topics: Angiotensin-Converting Enzyme Inhibitors; Calcium Channel Blockers; Cardiovascular Agents; Cohort Studies; Depressive Disorder; Female; Humans; Male; Middle Aged; Suicide

Certain medications used in cardiovascular therapeutics may contribute to the etiology of substance-induced mood disorders. These medications include digoxin, angiotensin converting enzyme (ACE) inhibitors, beta-blockers, and calcium channel blockers. The objective of this study was to evaluate associations between these drugs and clinical diagnoses of depressive disorders in a population of hospitalized patients.. Two case-control studies were conducted. For each study, subjects were selected from a health records data base maintained at the Calgary General Hospital. Selection of subjects in the first study was restricted to those receiving a discharge diagnosis of congestive heart failure and in the second study to subjects receiving a discharge diagnosis of hypertension. In each of these 2 studies, a single case group was selected along with 2 control groups: a psychiatric control group consisting of subjects receiving a psychiatric diagnosis other than a depressive disorder and a nonpsychiatric control group receiving no psychiatric diagnoses. Drug exposures and other variables were recorded from a chart review.. Exposures to digoxin, beta-blockers, and calcium channel blockers were not associated with depressive diagnoses. An association was observed, however, for ACE inhibitors. An elevated odds ratio (OR) was observed in each case-control study and was stronger in female subjects and subjects over the age of 65.. This is the first reported epidemiological evidence of an association between ACE inhibitors and depressive disorders. The design of this study does not permit a determination of whether the observed association was causal. Additional studies are needed.

Topics: Adult; Aged; Aged, 80 and over; Angiotensin-Converting Enzyme Inhibitors; Cardiovascular Agents; Cardiovascular Diseases; Case-Control Studies; Depressive Disorder; Female; Heart Failure; Humans; Hypertension; Male; Middle Aged; Odds Ratio; Patient Admission; Risk Factors

Electroconvulsive therapy (ECT) is often described as an effective and safe treatment of depression in the elderly. However, we have previously reported that there may be increased morbidity in this population, particularly in the very old. This paper extends this work to a second, larger sample of 136 subjects of whom 40 are over 60 years of age. We have again found that while ECT is efficacious, complications increase with age (r = .26; P less than or equal to .003), occurring in 35% of the elderly as opposed to 18% of the younger group. This increased rate of complications appears to be accounted for by problems in the very old; six of eight subjects over 75 years of age had some untoward event. Common complications in the elderly included severe confusion, falls, and cardiorespiratory problems. Complications in the whole sample were related to health status (r = .22; P less than or equal to .008) which in turn correlated with age (r = .50; P less than or equal to .0001). Those taking a greater total number of medications and a greater number of cardiovascular medications had significantly more complications during ECT. There was no relationship between either complications and outcome or complications and the number or laterality of treatments. These findings confirm the effectiveness of ECT in the elderly but suggest there may be unappreciated risks of ECT in this population. At particular risk are the very old, those in poor general health, and those taking multiple medications, particularly cardiovascular agents.

Topics: Age Factors; Aged; Cardiovascular Agents; Depressive Disorder; Drug Therapy, Combination; Electroconvulsive Therapy; Female; Humans; Male; Middle Aged; Risk

Topics: Antihypertensive Agents; Cardiovascular Agents; Depression; Depressive Disorder; Hypertension; Muscle Relaxants, Central; Secologanin Tryptamine Alkaloids

Topics: Animals; Barbiturates; Cardiovascular Agents; Depression; Depressive Disorder; Dogs; Heart; Heart Arrest