Depression and coronary heart disease: 2018 ESC Guideline
The European Society of Cardiology (ESC) has released its 2018 Practice Guidelines on Depression and coronary heart disease. Major depression is a highly prevalent condition, affecting approximately 10% of the population. It has been consistently associated with increased risk of coronary heart disease (CHD). The guidelines have appeared in European Heart Journal.
Evidence from both experimental and epidemiological studies indicates that there is a bidirectional association between depression and CHD. Depression is very common in patients with CHD and is an independent risk factor for poorer CHD outcomes.
There are several treatments options for the CHD patient with depression, from medications to various forms of psychotherapy, to exercise and stress management approaches. Although treatment of depression has not been shown to improve cardiovascular outcomes in CHD patients, depression should still be addressed if severe enough, in order to promote patient wellness and QoL.
Key Recommendations are -
- Clinicians should be aware of the high prevalence of depression in CHD patients. Screening for depression is recommended if patients have access to adequate care support systems
- Patients with positive screening results should be referred to a qualified health care provider in the management of depression
- Non-pharmacologic interventions such as exercise and psychotherapy should be considered as additional treatment options for CHD patients
- Harmonization of care between healthcare providers is essential in patients with combined CHD and depression
- Tricyclics should be avoided in this patient population.
|Drug classification/ generic name||Indication||Cardiovascular adverse effects||Other adverse effects|
|Selective serotonin reuptake inhibitors|
|Fluoxetine Sertraline Paroxetine Fluvoxamine Citalopram Escitalopram||Nausea, diarrhoea, headache, insomnia, agitation, loss of libido, delayed ejaculation, and erectile dysfunction|
|Imipramine Doxepine Amoxapine Nortriptyline Amitriptyline||Anticholinergic effects: dry mouth, constipation, memory problems, confusion, blurred vision, sexual dysfunction, and decreased urination, and memory impairment especially in the elderly|
|Serotonin-norepinephrine reuptake inhibitors|
|Desvenlafaxine Duloxetine Levomilnacipran Milnacipran Venlafaxine||Dizziness, constipation, dry mouth, headache, changes in sleep, or more rarely a serotonin syndrome, with restlessness, shivering, and sweating|
|Antidepressants with novel mechanisms of action|
|Buproprion||Weight loss, restlessness, high doses can rarely cause seizures|
|Mirtazapine||Sweating and shivering, tiredness, strange dreams, dyslipidemia, weight gain, anxiety, and agitation|
|Trazodone||Rarely, it can cause priapism|
For further reference log on to : https://doi.org/10.1093/eurheartj/ehy913