First Department of Psychiatry, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Greece; Department of Pharmacology, Medical School, National and Kapodistrian University of Athens, Greece.
Department of Clinical Therapeutics, Vascular Laboratory, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, 80 Vas. Sofias Str, Athens 11528, Greece.
J Affect Disord. 2019 Jun 1;252:190-200. doi: 10.1016/j.jad.2019.04.024. Epub 2019 Apr 9.
Major depression is associated with endothelial dysfunction and arterial stiffening, which may mediate development of hypertension and increased cardiovascular risk. The effect of response to antidepressant treatment on these vascular parameters has not been elucidated.
We aimed to assess the net effect of antidepressant therapy on endothelial function and arterial stiffness in patients with psychotic depression.
Thirty-seven patients with major psychotic depression, according to DSM-IV-TR, were treated with titrated citalopram 20-60 mg and risperidone 0.5-1 mg and were followed for 6 months. Twelve additional patients who denied treatment, or were non-compliant, were also followed for the same time period. Vascular function was assessed by flow-mediated dilatation (FMD), carotid-femoral pulse wave velocity (PWV) and augmentation index (AI), at baseline and at the end of follow-up.
Aortic and peripheral blood pressure (BP), PWV, FMD and AI (p < 0.05 for all) were significantly improved in the group that received treatment. Overall, only responders to treatment (n = 24) presented significant improvements in all hemodynamic and vascular parameters (p < 0.05 for all), irrespectively of traditional cardiovascular risk factors (TRFs), vasoactive medication and BP lowering. In a secondary analysis, patients with psychotic depression presented worse endothelial function as compared to controls matched for TRFs.
Non-randomized study.
Patients who respond to therapy for major psychotic depression present sustained improvement in vascular function. Given that depressed patients are considered to be at high cardiovascular risk and are often non-compliant with treatment, further research to assess cardiovascular benefits of vigilant monitoring of antidepressant therapy is warranted.
重度抑郁症与血管内皮功能障碍和动脉僵硬度有关，这可能会导致高血压和心血管风险增加。抗抑郁治疗反应对这些血管参数的影响尚未阐明。
我们旨在评估抗抑郁治疗对精神病性抑郁症患者血管内皮功能和动脉僵硬度的净效应。
37 名符合 DSM-IV-TR 标准的重度精神病性抑郁症患者接受西酞普兰滴定剂量 20-60mg 和利培酮 0.5-1mg 治疗，并随访 6 个月。另外 12 名拒绝治疗或不依从的患者也在同一时期进行了随访。在基线和随访结束时，通过血流介导的扩张（FMD）、颈动脉-股动脉脉搏波速度（PWV）和增强指数（AI）评估血管功能。
治疗组的主动脉和外周血压（BP）、PWV、FMD 和 AI 均显著改善（所有 p 值均<0.05）。总体而言，仅治疗应答者（n=24）在所有血流动力学和血管参数方面均有显著改善（所有 p 值均<0.05），而与传统心血管危险因素（TRFs）、血管活性药物和降压无关。在一项次要分析中，与匹配 TRFs 的对照组相比，精神病性抑郁症患者的内皮功能更差。
非随机研究。
对重度精神病性抑郁症进行治疗的患者血管功能持续改善。由于抑郁患者被认为具有较高的心血管风险，且经常不遵医嘱治疗，因此需要进一步研究来评估对抗抑郁治疗进行监测对心血管获益的影响。
