Mavrides Nicole, Nemeroff Charles B
Department of Psychiatry and Behavioral Sciences, Center on Aging, University of Miami Miller School of Medicine, Miami, Florida, USA.
Dialogues Clin Neurosci. 2015 Jun;17(2):127-40. doi: 10.31887/DCNS.2015.17.2/nmavrides.
Patients with cardiovascular disease (CVD) commonly have syndromal major depression, and depression has been associated with an increased risk of morbidity and mortality. Prevalence of depression is between 17% and 47% in CVD patients. Pharmacologic and psychotherapeutic interventions have long been studied, and in general are safe and somewhat efficacious in decreasing depressive symptoms in patients with CVD. The impact on cardiac outcomes remains unclear. The evidence from randomized controlled clinical trials indicates that antidepressants, especially selective serotonin uptake inhibitors, are overwhelmingly safe, and likely to be effective in the treatment of depression in patients with CVD. This review describes the prevalence of depression in patients with CVD, the physiological links between depression and CVD, the treatment options for affective disorders, and the clinical trials that demonstrate efficacy and safety of antidepressant medications and psychotherapy in this patient population. Great progress has been made in understanding potential mediators between major depressive disorder and CVD--both health behaviors and shared biological risks such as inflammation.
心血管疾病（CVD）患者通常伴有综合征性重度抑郁症，且抑郁症与发病率和死亡率增加相关。CVD患者中抑郁症的患病率在17%至47%之间。长期以来一直在研究药物和心理治疗干预措施，总体而言，这些干预措施在减轻CVD患者的抑郁症状方面是安全且有一定疗效的。对心脏结局的影响仍不明确。随机对照临床试验的证据表明，抗抑郁药，尤其是选择性5-羟色胺再摄取抑制剂，极其安全，且可能有效治疗CVD患者的抑郁症。本综述描述了CVD患者中抑郁症的患病率、抑郁症与CVD之间的生理联系、情感障碍的治疗选择，以及证明抗抑郁药物和心理治疗在该患者群体中疗效和安全性的临床试验。在理解重度抑郁症与CVD之间的潜在中介因素方面已取得了很大进展，这些中介因素包括健康行为和诸如炎症等共同的生物学风险。
