Kitzlerová Eva, Anders Martin
Department of Psychiatry, 1st Faculty of Medicine, Charles University Prague and General Teaching Hospital, Czech Republic.
Neuro Endocrinol Lett. 2007 Dec;28(6):832-40.
Depressive disorders and cardiovascular disease are inter-connected by a whole range of pathophysiological mechanisms. Three biological mechanisms are fundamental: activation of the hypothalamus-hypohysis-adrenal axis with a subsequent increase in sympathetic-adrenal system activity, decrease in vagal tone with a decrease in heart rate variability, and alterations of thrombogenesis with increased platelet aggregability. Behavioural mechanisms and psycho-social factors are also integral to this common pathophysiology. Recently, research has focused mainly on studying various forms of stress, as well as changes and possibilities of influencing the autonomous vegetative system. Temporal aspects of the incidence and development of depressive episodes in relation to cardiovascular disease and subsequent cardiovascular morbidity and mortality are being studied, as well as general mortality risk factors. These findings are important for clinical practice. It is evident that in patients with untreated depressive disorder, the risk of developing cardiovascular disease is significantly higher than in patients suffering from a depressive disorder being treated with anti-depressants. From the data published so far, it may be surmised that depressive disorders in patients with cardiovascular disease may be reliably and safely treated with anti-depressants that act as inhibitors of serotonin re-uptake.
抑郁症与心血管疾病通过一系列病理生理机制相互关联。三种生物学机制至关重要：下丘脑 - 垂体 - 肾上腺轴激活，随后交感 - 肾上腺系统活动增加；迷走神经张力降低，心率变异性下降；血栓形成改变，血小板聚集性增加。行为机制和心理社会因素在这种共同的病理生理过程中也不可或缺。最近，研究主要集中在研究各种形式的压力，以及影响自主神经系统的变化和可能性。正在研究与心血管疾病相关的抑郁发作的发生和发展的时间方面，以及随后的心血管发病率和死亡率，还有一般死亡风险因素。这些发现对临床实践很重要。显然，在未治疗的抑郁症患者中，患心血管疾病的风险明显高于接受抗抑郁药治疗的抑郁症患者。从目前公布的数据来看，可以推测心血管疾病患者的抑郁症可用作为5-羟色胺再摄取抑制剂的抗抑郁药进行可靠且安全的治疗。
