心血管疾病与抑郁症的病理生理学基础：一个先有鸡还是先有蛋的困境。
Pathophysiological basis of cardiovascular disease and depression: a chicken-and-egg dilemma.
机构信息
The John Curtin School of Medical Research, Australian National University, Canberra, Australia.
出版信息
Braz J Psychiatry. 2010 Jun;32(2):181-91. doi: 10.1590/s1516-44462010000200015.
OBJECTIVE
To describe the pathophysiological basis linking cardiovascular disease (CVD) and depression; to discuss the causal relationship between them, and to review the effects of antidepressant treatment on cardiovascular disease.
METHOD
A review of the literature based on the PubMed database.
DISCUSSION
Depression and cardiovascular disease are both highly prevalent. Several studies have shown that the two are closely related. They share common pathophysiological etiologies or co-morbidities, such as alterations in the hypothalamic-pituitary axis, cardiac rhythm disturbances, and hemorheologic, inflammatory and serotoninergic changes. Furthermore, antidepressant treatment is associated with worse cardiac outcomes (in case of tricyclics), which are not observed with selective serotonin reuptake inhibitors.
CONCLUSION
Although there is a strong association between depression and cardiovascular disease, it is still unclear whether depression is actually a causal factor for CVD, or is a mere consequence, or whether both conditions share a common pathophysiological etiology. Nevertheless, both conditions must be treated concomitantly. Drugs other than tricyclics must be used, when needed, to treat the underlying depression and not as mere prophylactic of cardiac outcomes.
目的
描述心血管疾病 (CVD) 和抑郁症之间的病理生理联系；讨论它们之间的因果关系，并回顾抗抑郁治疗对心血管疾病的影响。
方法
基于 PubMed 数据库进行文献回顾。
讨论
抑郁症和心血管疾病的发病率都很高。多项研究表明，两者密切相关。它们具有共同的病理生理病因或共病，如下丘脑-垂体轴改变、心律失常以及血液流变学、炎症和 5-羟色胺能改变。此外，抗抑郁治疗与更差的心脏结局相关（三环类抗抑郁药），而选择性 5-羟色胺再摄取抑制剂则没有观察到这种情况。
结论
尽管抑郁症和心血管疾病之间存在很强的关联，但仍不清楚抑郁症实际上是否是 CVD 的因果因素，或者仅仅是后果，或者这两种情况是否具有共同的病理生理病因。然而，这两种情况都必须同时治疗。在需要时，应使用除三环类抗抑郁药以外的药物来治疗潜在的抑郁症，而不是仅仅作为心脏结局的预防性药物。
Zotero 插件