Norra Christine, Skobel Eric C, Arndt Marlies, Schauerte Patrick
Department of Psychiatry and Psychotherapy, University Hospital, Aachen, Germany.
Int J Cardiol. 2008 Apr 10;125(2):220-31. doi: 10.1016/j.ijcard.2007.05.020. Epub 2007 Jul 26.
Depressive syndromes in chronic heart failure (CHF) are common and are associated with a poorer prognosis, particularly with increased morbidity and mortality. CHF as a severe physical disorder may increase the risk of developing depressive syndromes or vice-versa as an interaction of possible common psycho-organic etiological aspects. Depression in CHF is associated with impaired NYHA status and daily activities, resulting in enhanced hospitalisation rates and medical costs with a great impact on long-term health. Only a fraction of comorbid patients receives antidepressants. Therefore, identification of risk factors and prevention by optimizing cardiological and psychiatric therapeutic strategies appear essential for these patients. Early diagnosis and treatment of both CHF and depression may prevent further pathophysiological effects on the heart and brain. This review gives a comprehensive overview of the occurrence, risk factors and shared pathophysiology of depression in CHF, and focuses on improving insufficient diagnosis and therapy of depression. Special attention is given on the cardiac effects of psychopharmacological and alternate non-pharmacological antidepressant therapy in CHF. Recommendations are made for treating depression in CHF patients for a better prevention of this disabling physical and psychosocial condition.
慢性心力衰竭（CHF）中的抑郁综合征很常见，且与较差的预后相关，尤其是发病率和死亡率增加。CHF作为一种严重的身体疾病，可能会增加患抑郁综合征的风险，反之亦然，这可能是由于常见的心理 - 器质性病因方面的相互作用。CHF中的抑郁症与纽约心脏协会（NYHA）心功能分级及日常活动受损有关，导致住院率和医疗费用增加，对长期健康产生重大影响。只有一小部分合并患者接受抗抑郁药治疗。因此，识别危险因素并通过优化心脏和精神治疗策略进行预防，对这些患者来说似乎至关重要。早期诊断和治疗CHF及抑郁症可能会预防对心脏和大脑的进一步病理生理影响。本综述全面概述了CHF中抑郁症的发生、危险因素和共同的病理生理学，并着重于改善抑郁症诊断和治疗不足的情况。特别关注了CHF中精神药理学和替代性非药物抗抑郁治疗对心脏的影响。针对治疗CHF患者的抑郁症提出了建议，以便更好地预防这种致残的身体和心理社会状况。
