Despite mounting evidence that depressive symptoms increase the risk of morbidity and mortality in patients who have coronary artery disease, little is known about the biologicmechanisms that underlie this association...Despite mounting evidence that depressive symptoms increase the risk of morbidity and mortality in patients who have coronary artery disease, little is known about the biologicmechanisms that underlie this association. This study examined whether depressive symptoms are associated with markers of infection and inflammation that have been implicated in the pathogenesis of coronary artery disease. Sixty-five patients who were recovering from an acute coronary syndrome were enrolled(63%men; mean age 61 years, 90%white). Depressive symptoms were assessed through self-report and observer ratings; the inflammatory molecules C-reactive protein, interleukin-6, and tumor necrosis factor-αwere measured in serum, as were antibody titers to 3 latent viruses associated with atherosclerosis. Patients who had more severe depressive symptoms exhibited higher levels of C-reactive protein(r=0.27, p=0.03) and higher rates of seropositivity to the latent viruses(r=0.41, p=0.001). These effects were large in magnitude: patients in the highest tertile of the depression distribution had C-reactive protein levels >50%higher than did patients in the middle and lowest tertiles; they also were 2 times as likely to show evidence of infection with all 3 latent viruses. Disparities in the extent, severity, or management of cardiac disease were not responsible for these associations. These findings provide evidence that depressive symptoms are associated with increases in C-reactive protein and pathogen burden in patients who have coronary artery disease. In doing so, they highlight a mechanism through which depressive symptoms might foster morbidity and mortality among patients who have cardiac disease.展开更多
Depression occurs in approximately 45%of all patients with Parkinsons disea se (PD), reduces quality of life independent of motor symptoms and seems to be u nderrated and undertreated. Characteristics of symptoms di...Depression occurs in approximately 45%of all patients with Parkinsons disea se (PD), reduces quality of life independent of motor symptoms and seems to be u nderrated and undertreated. Characteristics of symptoms differ from major depres sion. Because of overlapping clinical symptoms, diagnosis is based on subjective ly experienced anhedonia and feeling of emptiness. Available rating scales for m ajor depression may not be adequate to correctly measure severity of depression in PD. Anxiety and depression may manifest as first symptoms of PD many years be fore motor symptoms. Serotonergic, noradrenergic and dopaminergic mechanisms pla y key roles in the etiology of depression in PD. Tricyclic and newer, selective antidepressants including serotonin and noradrenaline reuptake inhibitors (SSRI, SNRI) appear to be effective in treating depression in PD. Selective reuptake i nhibitors seem to have a favorable side effect profile. Recent controlled studie s show antidepressant effects of pramipexole in bipolar II depression. New dopam ine agonists pramipexole and ropinirole appear to ameliorate depressive symptoms in PD in addition to effects on motor symptoms. There is a lack of appropriate rating scales and controlled studies regarding depression in PD.展开更多
文摘Despite mounting evidence that depressive symptoms increase the risk of morbidity and mortality in patients who have coronary artery disease, little is known about the biologicmechanisms that underlie this association. This study examined whether depressive symptoms are associated with markers of infection and inflammation that have been implicated in the pathogenesis of coronary artery disease. Sixty-five patients who were recovering from an acute coronary syndrome were enrolled(63%men; mean age 61 years, 90%white). Depressive symptoms were assessed through self-report and observer ratings; the inflammatory molecules C-reactive protein, interleukin-6, and tumor necrosis factor-αwere measured in serum, as were antibody titers to 3 latent viruses associated with atherosclerosis. Patients who had more severe depressive symptoms exhibited higher levels of C-reactive protein(r=0.27, p=0.03) and higher rates of seropositivity to the latent viruses(r=0.41, p=0.001). These effects were large in magnitude: patients in the highest tertile of the depression distribution had C-reactive protein levels >50%higher than did patients in the middle and lowest tertiles; they also were 2 times as likely to show evidence of infection with all 3 latent viruses. Disparities in the extent, severity, or management of cardiac disease were not responsible for these associations. These findings provide evidence that depressive symptoms are associated with increases in C-reactive protein and pathogen burden in patients who have coronary artery disease. In doing so, they highlight a mechanism through which depressive symptoms might foster morbidity and mortality among patients who have cardiac disease.
文摘Depression occurs in approximately 45%of all patients with Parkinsons disea se (PD), reduces quality of life independent of motor symptoms and seems to be u nderrated and undertreated. Characteristics of symptoms differ from major depres sion. Because of overlapping clinical symptoms, diagnosis is based on subjective ly experienced anhedonia and feeling of emptiness. Available rating scales for m ajor depression may not be adequate to correctly measure severity of depression in PD. Anxiety and depression may manifest as first symptoms of PD many years be fore motor symptoms. Serotonergic, noradrenergic and dopaminergic mechanisms pla y key roles in the etiology of depression in PD. Tricyclic and newer, selective antidepressants including serotonin and noradrenaline reuptake inhibitors (SSRI, SNRI) appear to be effective in treating depression in PD. Selective reuptake i nhibitors seem to have a favorable side effect profile. Recent controlled studie s show antidepressant effects of pramipexole in bipolar II depression. New dopam ine agonists pramipexole and ropinirole appear to ameliorate depressive symptoms in PD in addition to effects on motor symptoms. There is a lack of appropriate rating scales and controlled studies regarding depression in PD.
