At the Heart of Depression: 3 New Studies

August 16, 2018

New research brings us closer to learning about the associations between psychological states, quality of life, and cardiovascular health.

Three new studies about the association between depression and heart disease find the following: brain regions related to short-term memory and negative emotions are strongly connected in depression and may lead to poor sleep quality; depression and anxiety present in about one-third of patients with heart failure; and antidepressants may increase the risk of venous thromboembolism. For more information, see: Depression and Anxiety in Cardiac Disease

Increased functional connectivity between brain regions provides a neural basis for the association of depression with poor sleep quality, which has implications for the treatment of depression and poor sleep quality. Data was collected from 1017 participants in the Human Connectome Project, including a survey of self-reported sleep quality and resting-state functional magnetic resonance imaging. A total of 162 functional connectivity links involving areas associated with sleep, such as the precuneus, anterior cingulate cortex, and the lateral orbitofrontal cortex, were identified. Of these links, 39 were also associated with the Depressive Problems scores. A mediation analysis showed that these functional connectivities underlie the association of the Depressive Problems score with poor sleep quality.

Clinical Implications: “The understanding that we develop here is consistent with areas of the brain involved in short-term memory (the dorsolateral prefrontal cortex), the self (precuneus), and negative emotion (the lateral orbitofrontal cortex) being highly connected in depression, and that this results in increased ruminating thoughts which are at least part of the mechanism that impairs sleep quality,” said senior author Jianfeng Feng of the Department of Computer Science at the University of Warwick in Coventry, United Kingdom.

Source: Cheng W, Rolls ET, Ruan H, Feng J. Functional Connectivities in the Brain That Mediate the Association Between Depressive Problems and Sleep Quality. JAMA Psychiatry. 2018 July. [Epub ahead of print]

Depression and anxiety are underdiagnosed and undertreated in patients with heart failure. A targeted literature review identified associations between depression, anxiety, and heart failure; examined mechanisms mediating relationships between these conditions and medical outcomes; and identified methods for accurately diagnosing depression and anxiety disorders in heart failure. The results show both depression and anxiety disorders are associated with the development and progression of heart failure, including increases in mortality, likely mediated through both physiologic and behavioral mechanisms. Studies reported that one-third of heart failure patients report elevated symptoms of depression on standard questionnaires, while 19% meet diagnostic criteria for major depression or other depressive disorders.

Clinical Implications: “It is likely that an aggressive, multimodal treatment approach-such as collaborative care models or stepped care from a mental health professional-will be needed to improve psychiatric and cardiac health in this high-risk population,” stated the researchers, led by Christopher Celano, MD, of Massachusetts General Hospital. Cognitive behavioral therapy has been shown to improve mental health outcomes in patients with heart failure, and selective serotonin reuptake inhibitors appear to be safe, they stated.

Source: Celano CM, Villegas AC, Albanese AM, et al. Depression and Anxiety in Heart Failure: A Review. Harv Rev Psychiatry. 2018;26:175-184.

Antidepressants may raise the risks of venous thromboembolism. Previous studies of the connection between depression and venous thromboembolism have reported mixed results. A systematic review and meta-analysis of published observational studies, including 8 observational studies with data on 960,113 non-overlapping participants and 9027 venous thromboembolism cases, were included in an evaluation of the associations between depression and antidepressant use with venous thromboembolism risk. Overall, there was a 27% increase in the risk of venous thromboembolism with antidepressant use as compared to no antidepressant use. Tricyclic antidepressants, selective serotonin reuptake inhibitors, and other antidepressants were each associated with an increased venous thromboembolism risk.

Clinical Implications: “Pooled observational evidence suggests that depression and use of antidepressants are each associated with an increased venous thromboembolism risk. The effect of antidepressant drugs on venous thromboembolism may be a class effect,” stated the researchers, led by Setor Kunutsor, Research Fellow from the Musculoskeletal Research Unit at the Bristol Medical School in Bristol, UK. “These findings are very useful to me as both a clinician and a researcher. It gives me the information I need, especially when prescribing antidepressant medications to my patients,” said Kunutsor.

Source: Kunutsor SK, Seidu S, Khunti K. Depression, antidepressant use, and risk of venous thromboembolism: systematic review and meta-analysis of published observational evidence. Ann Med. 2018 July [epub ahead of print].