Thomas C.Baghai, M.D.

Director Medical Services, Medical Institutions District Oberpfalz

Professorship for Clinical Neurosciences, University Regensburg

Background

Cardiovascular disorders (CVD) and major depressive disorder (MDD) are the most frequent diseases worldwide responsible for premature death and disability. Behavioral and immunological variables influence the pathophysiology of both disorders. We determined frequency and severity of MDD in CVD and studied whether MDD without CVD or other somatic diseases influences classical and inflammatory biomarkers of cardiovascular risk. In addition, we determined the n-3 PUFA status in major depressed patients and investigated the influence of proinflammatory cytokines on antidepressant treatment outcome.

Methods

In a case-control design 310 adults (MDD patients without CVD, CVD patients, and cardiovascularly and psychiatrically healthy matched controls) were investigated. MDD patients were recruited after admission in a psychiatric university hospital. Primary outcome criteria were clinical depression ratings (HAM-D scale), vital signs, classical cardiovascular risk factors and inflammatory biomarkers which were compared between MDD patients and healthy controls.

Results

We detected an enhanced cardiovascular risk in MDD. Untreated prehypertension and signs directing to a metabolic syndrome were detected in MDD. Significantly higher inflammatory biomarkers (hsCRP, proinflammatory cytokines IL-6 and IL-1b) underlined the higher cardiovascular risk in physically healthy MDD patients. Simultanously depressed patients showed lower concentrations of n-3 polyunsaturated fatty acids in comparison to healthy controls. Surprisingly, high inflammation markers before treatment were associated with better clinical outcome and faster remission. The rate of MDD in CVD patients was high.

Conclusions

Patients suffering from MDD are at specific risk for CVD. Precise detection of cardiovascular risks in MDD beyond classical risk factors is warranted to allow effective prophylaxis and treatment of both conditions. Future studies of prophylactic interventions may help to provide a basis for prophylactic treatment of both MDD and CVD. In addition, the high risk for MDD in CVD patients was confirmed and underlines the requirement for clinical attention.