Heart disease depression with

Depression is one of the most common conditions in the UK, affecting one in five people at some stage in their life. The World Health Organization (WHO) estimates that by 2020 depression will be the biggest global health concern after chronic heart disease. Depression occurs in children, adolescents, women in menopause, the elderly, or those with mental disorder, especially in menopause. - The symptom of depression in menopause will cause mood obstacles about 10 years later. - ... 

The multifactorial nature of depression resembles that of other complex disorders such as diabetes mellitus or coronary heart disease. Indeed, research has increasingly discovered the relevance of depressive symptoms for the development and course of diabetes, particularly in diabetes type 2, with up to one fourth of all patients with diabetes mellitus suffering from depressive symptoms up to and including states of depressive disorders (Kruse et al., 2006). Similarly, an independent association has been found between major depression and coronary heart disease (Perlmutter et al., 2000). Indeed, the 1-month prevalence of depression in coronary heart disease patients is approximately 15%, threefold higher than that observed in the community (Rozanski et al., 1999). In patients with coronary heart disease, depression has been associated with a 2.5 -fold increase in the occurrence of cardiovascular events (Rozanski et al., 1999). Recent evidence has brought to notice the important role of NO in this connection (Chrapko et al, 2004), which not only is an important... 

Depression is a common, serious, sometimes fatal illness that is chronic and recurrent in nature, impairs family life, reduces social adjustment, and is a burden on the community (Klerman and Weissman, 1992). This disease chronicity magnifies hoth its societal impact and its economic burden. It has been estimated that more than 17% of the disability associated with mental disorders is the result of depressive disorders (Rosenbaum and Hylan, 1999), and that the global burden of depression, measured in terms of disability-adjusted life years, will rank second only to ischaemic heart disease by the year 2020 (Murray and Lopez, 1996). 

The problems of alcohol dependence and alcoholism are dealt with in Chapter 10. Suffice it to say here that problem drinkers risk numerous psychological problems, such as anxiety and depression, and may experience physical withdrawal symptoms. There are also numerous medical problems related to heavy, chronic alcohol consumption these include increased risk of coronary heart disease, liver cirrhosis, impotence and infertility, cancer and stroke (Chapter 10). It is estimated that alcohol plays a part in up to 33,000 deaths per year in the UK (DoH, 2001). Within the last year 1 in 4 adults will have experienced loss of memory following an alcoholic binge, injured themselves or... 

We still need much better medicines to cure cancer, heart disease, stroke, and Alzheimer s disease. We need better drugs to deal with obesity, diabetes, arthritis, and schizophrenia. The treatments of diabetes, arthritis, and mental defects such as schizophrenia or manic depression are not yet cures, just ways to keep the symptoms under control. Cures are needed. Insights from genetics may help guide us toward elegant and rational cures, but we will also make use of screens to identify natural products and libraries of randomly generated synthetic compounds (combinatorial chemistry). A semi-empirical approach may be the best hope over the next two decades to yield drugs to alleviate these diseases. 

It has been estimated that in 2020 the number of people suffering from depression and anxiety disorders will be second only to those with ischemic heart disease. With this perspective one obvious question to ask is why is so little research done concerning the relationship between the function of the brain and what makes us content with our life ... 

Of greater concern is the safety of the TCAs. Toxic levels of these medications can produce lethal cardiac arrhythmias, seizures, and suppression of breathing. An overdose of a 1-2 week supply of most TCAs is often fatal, a serious consideration when prescribing medication to depressed patients with suicidal thoughts. Children taking imipramine for treatment of ADHD have died from sudden cardiac death consequently, child psychiatrists seldom use TCAs. Likewise, patients with heart disease or seizure disorders are more likely to have dangerous complications from TCAs and should avoid them. 

CHF Use with caution in patients with CHF and in those with acute ischemic heart disease or cardiomyopathy because even slight depression of myocardial contractility may further reduce cardiac output of the damaged heart. 

Use caution in patients with a recent history of Ml or unstable heart disease. Bupropion was well tolerated in depressed patients who had previously developed orthostatic hypotension while receiving tricyclic antidepressants and was generally well tolerated in depressed patients with stable CHF. Bupropion was associated P.784... 

Isoflurane (Forane) is a structural isomer of enflurane and produces similar pharmacological properties some analgesia, some neuromuscular blockade, and depressed respiration. In contrast, however, isoflurane is considered a particularly safe anesthetic in patients with ischemic heart disease, since cardiac output is maintained, the coronary arteries are dilated, and the myocardium does not appear to be sensitized to the effects of catecholamines. Also, blood pressure falls as a result of vasodilation, which preserves tissue blood flow. Isoflurane causes transient and mUd tachycardia by direct sympathetic stimulation this is particularly important in the management of patients with myocardial ischemia. 

Roose SR Laghrissi-Thode F, Kennedy IS, et al. Comparison of paroxetine and nortriptyline in depressed patients with ischemic heart disease. lAMA i998 279 287-29i. 

Depressive disorders can lead to death in other ways (Table 6-9). For example, depressed individuals are more prone to accidents that result from their impaired concentration and attention. They also often attempt to self-medicate, particularly with alcohol or other sedative agents, which may lead to death as a result of organ toxicity, as well as accidents. Psychotic depressive patients may act irrationally, putting themselves at greater physical risk. Although rare today, patients have died of severe malnutrition secondary to catatonic symptoms that precluded the ability to care for their basic needs. Depression can also contribute to a higher morbidity and mortality rate in patients with co-morbid medical disorders. For example, a large database indicates that depression may predispose to the development of ischemic heart disease and increase the risk of cardiac-related death ( 51). 

Roose SP, Spatz E. Treatment of depression in patients with heart disease. J Clin Psychiatry 1999 60[Suppl 20] 34-37. 

Sudden death has occurred in patients with preexisting heart disease on antidepressant therapy. It may be difficult, however, to separate a causally related drug effect from a cardiovascular incident precipitated by other factors and only by chance coincident with drug therapy. Furthermore, Roose ( 418), who has summarized the literature, noted that major depressive disorder occurs frequently after a myocardial infarct and may adversely affect the recovery process. 

Roose SP, Glassman AH. Cardiovascular effects of TCAs in depressed patients with and without heart disease. J Ctin Psychiatry Monogr Ser 1989 7 1-18. 

Although ketamine produces direct myocardial depression, it has significant indirect cardiovascular effects through sympathomimetic effects and stimulation of the vasomotor centre. The heart rate and systolic blood pressure increase by 30% and occasionally up to 100%. Owing to the increased cardiac work and myocardial consumption, ketamine adversely affects the balance between myocardial oxygen supply and demand. Consequently, it is not recommended for use as the sole agent in adults with severe cardiovascular disease. However, the same haemodynamic effects, particularly the raised systemic vascular resistance, make the agent particularly suitable for children with cyanotic heart disease. 

Investigators from the Department of Pediatrics in Johns Hopkins Hospital, after seeing a neonate who had marked leukocytosis temporally related to alprostadil, conducted a retrospective study of neonatal leukocytosis induced by alprostadil in 45 neonates (5). They concluded that alprostadil infusion is a predictable cause of leukocytosis in neonates with congenital heart disease. Alprostadil-induced leukocytosis was especially prominent in three patients with splenic disorders associated with the hetero-taxy syndrome. Many of the other adverse effects of alprostadil, including respiratory depression, hypotension, fever, and lethargy, were also associated with sepsis. The authors considered that it is reasonable to look for sepsis in infants receiving alprostadil, but that it is equally reasonable to withdraw empirical therapy once infection has been ruled out. Leukocytosis associated with alprostadil infusion has not been previously reported and is not listed in the alprostadil package insert. 

We are not certain which comorbid risk factors cause mortality independent of sleep effects, and therefore, we cannot be certain whether we controlled too much or too little for comorbidities. For example, since short sleep or long sleep may cause a person to be sick at present or to get little exercise or to have heart disease (17), diabetes (18), etc., controlling for these possible mediating variables may have incorrectly minimized the hazards associated with sleep durations. This would be overcontrol. The hazard ratios for participants who were rather healthy at the time of the initial questionnaires were unlikely to be overcontrolled for initial illness. Since the 32-covariate models and the hazard ratios for initially healthy participants were similar, this similarity reduced concern that the 32-covariate models were overcontrolled. On the other hand, there may have been residual confounding processes that caused both short or long sleep and early death that we could not adequately control in the CPSII data set, either because available control variables did not adequately measure the confound or because the disease did not yet manifest itself. Depression, sleep apnea, and dysregulation of cytokines are plausible confounders that were not adequately controlled. It may be impossible to be confident that all conceivable confounds are adequately controlled in epidemiological studies of sleep. 

Progressive inactivity, dissatisfaction with social life, and presence of medical and psychiatric illness can be most predictive of insomnia in old age [6, 7], In modern societies higher rates of insomnia are present in women, people who are less educated or unemployed, separated or divorced, the medically ill, and those with depression, anxiety, or substance abuse [8], In a number of studies, insomnia has been found to be correlated with frequent use of medical facilities [9-13], chronic health problems [13-18], perceived poor health [17], increased use of drugs [10,14], and specific medical conditions including respiratory diseases [19-21], hypertension [21], musculoskeletal and other painful disorders [19-24], heart diseases [19, 23], and prostate problems [19], On the other hand, chronic insomnia predisposes to the development of psychiatric disorders [25-27], Therefore, it is important to clearly establish whether co-morbidities are causative for, or simply co-exist with insomnia, in order to recommend the most appropriate treatment. This is why it is better to categorize insomnia as a disease rather than as a symptom [28],... 

---