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P.2.g.016 Depressive symptoms in coronary artery disease patients: association with neuro-endocrine factors
P.2.g. Affective disorders and antidepressants − Other (clinical) depressed outpatients which completed self-rating questionnaires reported painful somatic symptoms that included stomach pain, neck and back pain, headache and nonspecific generalized pain. Approximatively 92% from hospitalized patients with depression reported at least one painful symptom and 76% reported the presence of multiple painful symptoms. In the brain stem, the neurotransmitters serotonin and norepinephrine modulate pain transmission through ascending and descending neural pathways. Serotonin and norepinephrine are also involved in the pathophysiology of depression. Selective serotonin reuptake inhibitors provide some benefit. Duloxetine, a serotonin and norepinephrine reuptake inhibitor, alleviate pain and depressive symptoms. Methods: Sample A (escitalopram) was composed by 22 patients (15 female and 7 man, mean age 51.75); Sample B (duloxetine) was composed by 25 patients (18 female, 7 man, mean age 53.85). They were diagnosed with major depressive disorder according to ICD 10; assessed with HAMD 17 items in baseline and at 14, 28, 42, 56 days; CGI-S at baseline, at 28 days and at 56 days; CGI-I at 28 days and at 56 days. Results: Patients received: Escitalopram 10−20 mg/day or duloxetine 60–120 mg/day. All treated patients had a good evolution with a significant improvement on HAMD total score. Sample A: Total score HAMD 17 items was: at baseline − 21.8; at 14 days − 19.7; at 28 days − 17.2; at 42 days − 13.5; at 56 days − 11.8. Sample B: Total score HAMD 17 items was: at baseline − 22.3; at 14 days − 19.9; at 28 days − 17.4; at 42 days − 13.2; at 56 days − 10.5. Item 13 (somatic/general) − diffuse or vague muscle aches or heaviness in the arms or legs mean baseline score for Sample A − 1.65; Sample B − 1.75; At 56 days: Sample A − 0.80 and Sample B − 0.65. CGIS: mean baseline Sample A: 4.2 and Sample B: 4.3; At 56 days Sample A − 1.9 and Sample B − 1.5. CGII 56 days: Sample A 7/22 (31.8%) − much improved and 10/22 (45.45%) very much improved; Sample B 11/25 (44%) much improved and 14.25 (56%) very much improved. Side effects: We noted mild nausea at 20 patients at the beginning of the treatment (both samples), mild restlessness at 12 patients at the beginning of the treatment (both samples), mild dizziness at 9 patients at the beginning of the treatment (both samples). Conclusions: (1) Escitalopram and duloxetine are safe and effective treatments. (2) Coexistence of depression with physical pain negatively affects the performance in daily activity and quality of life; in such cases the first treatment option could be duloxetine. (3) Escitalopram is also efficient as a treatment for depression associated with important somatic/general complaints. References [1] Goldstein DJ, Detke MJ, Wiltse C, Mallinckrodt C, Demitrack MA. Duloxetine in the treatment of depression:a double blind placebo controlled comparison with paroxetine. J Clin Psychopharmacology 2004; 24; 389−99.
P.2.g.016 Depressive symptoms in coronary artery disease patients: association with neuro-endocrine factors A. Bunevicius1 ° , V. Gintauskiene2 , J. Brozaitiene2 , R. Bunevicius2 . 1 Lithuanian University of Health Sciences, Institute of Psychophysiology and Rehabilitation, Kaunas, Lithuania; 2 Lithuanian University of Health Sciences, Institute of Psychophysiology and Rehabilitation, Palanga, Lithuania Purpose: It is well known that depression is associated with abnormalities in thyroid axis function and in stress response
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systems [1,2]. However the association of neuro-endocrine factors, such as thyroid axis function and cortisol levels, with depression in coronary artery disease (CAD) patients remains poorly understood [3]. Therefore the aim of this study was to evaluate the association between depression, thyroid axis function and cortisol levels in CAD patients. Methods: A total of 83 (65 men and 18 women; mean age 55±9 years) consecutive patients diagnosed with CAD attending a rehabilitation program within 2 week after treatment of acute myocardial infarction or an episode of chest angina at the cardiac in-patient department agreed to participate in the study. All patients were evaluated for socio-demographic characteristics, for CAD severity according to the New York Heart Association (NYHA) functional class and for symptoms of depression using the Beck depression inventory (BDI). Also, serum levels of thyroid axis hormones, including thyroid stimulating hormone (TSH), free thyroxine (T4) and free tri-iodothyronine (T3); and cortisol concentrations at awakening and in the afternoon as well as difference between two concentrations (delta cortisol) were evaluated in all patients. First, we compared endocrine measures in patients with moderate to severe depressive symptoms with patients exhibiting mild or no depressive symptoms. Next, we tried to identify independent predictors of depressive symptoms in CAD patients by performing multivariate regression analysis. Results: Ten (12%) patients had moderate to severe depressive symptoms. Patients with moderate to severe depressive symptoms when compared to patients with mild or no depressive symptoms had lower free T3 levels (4.5±0.8 and 5.2±0.9, respectively, p = 0.03), higher afternoon cortisol levels (7.9±8.1 and 4.1±2.8, respectively, p = 0.02) and lower delta cortisol (10.1±6.2 and 14.8±5.8, respectively, p = 0.004). Multivariate regression analysis revealed than when thyroid axis hormones, cortisol, NYHA class, age, gender and education were included to the model female gender (beta=0.43, p = 0.001) and delta cortisol (beta=-0.2, p = 0.049) were independent predictors of depressive symptoms and explained 25% of variance of score on the BDI (p < 0.001). Conclusions: Lower change in cortisol concentrations together with female gender were independent predictors of higher levels of depressive symptoms in CAD patients. On the other hand, CAD disease severity did not predict depressive symptoms, suggesting that depressive symptoms in CAD patients might be associated with neuro-endocrine dysfunction, but not with CAD disease severity. Also, CAD patients with moderate to severe depression had blunted thyroid axis functions and increased activity of hypothalamic–pituitary–adrenal axis when compared to patients without clinically significant depressive symptoms corresponding to findings from studies in non-CAD patients. Further longitudinal studies evaluating clinical significance of the association between depression and neuro-endocrine factors, including thyroid axis function and hypothalamic–pituitary–adrenal axis function, in patients diagnosed with CAD needed. References [1] Bunevicius R., 2009 Thyroid disorders in mental patients. Curr Opin Psychiatry 22(4), 391–395. [2] Bunevicius R., Prange A.J., Jr., 2006 Psychiatric manifestations of Graves’ hyperthyroidism: pathophysiology and treatment options CNS Drugs 20(11), 897–909. [3] Bunevicius R., Varoneckas G., Prange A.J., Jr., Hinderliter A.L., Gintauskiene V., Girdler S.S., 2006 Depression and thyroid axis function in coronary artery disease: impact of cardiac impairment and gender. Clin Cardiol 29(4), 170–174.
P.2.g.016 Depressive symptoms in coronary artery disease patients: association with neuro-endocrine factors A. Bunevicius1 ° , V. Gintauskiene2 , J. Brozaitiene2 , R. Bunevicius2 . 1 Lithuanian University of Health Sciences, Institute of Psychophysiology and Rehabilitation, Kaunas, Lithuania; 2 Lithuanian University of Health Sciences, Institute of Psychophysiology and Rehabilitation, Palanga, Lithuania Purpose: It is well known that depression is associated with abnormalities in thyroid axis function and in stress response
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systems [1,2]. However the association of neuro-endocrine factors, such as thyroid axis function and cortisol levels, with depression in coronary artery disease (CAD) patients remains poorly understood [3]. Therefore the aim of this study was to evaluate the association between depression, thyroid axis function and cortisol levels in CAD patients. Methods: A total of 83 (65 men and 18 women; mean age 55±9 years) consecutive patients diagnosed with CAD attending a rehabilitation program within 2 week after treatment of acute myocardial infarction or an episode of chest angina at the cardiac in-patient department agreed to participate in the study. All patients were evaluated for socio-demographic characteristics, for CAD severity according to the New York Heart Association (NYHA) functional class and for symptoms of depression using the Beck depression inventory (BDI). Also, serum levels of thyroid axis hormones, including thyroid stimulating hormone (TSH), free thyroxine (T4) and free tri-iodothyronine (T3); and cortisol concentrations at awakening and in the afternoon as well as difference between two concentrations (delta cortisol) were evaluated in all patients. First, we compared endocrine measures in patients with moderate to severe depressive symptoms with patients exhibiting mild or no depressive symptoms. Next, we tried to identify independent predictors of depressive symptoms in CAD patients by performing multivariate regression analysis. Results: Ten (12%) patients had moderate to severe depressive symptoms. Patients with moderate to severe depressive symptoms when compared to patients with mild or no depressive symptoms had lower free T3 levels (4.5±0.8 and 5.2±0.9, respectively, p = 0.03), higher afternoon cortisol levels (7.9±8.1 and 4.1±2.8, respectively, p = 0.02) and lower delta cortisol (10.1±6.2 and 14.8±5.8, respectively, p = 0.004). Multivariate regression analysis revealed than when thyroid axis hormones, cortisol, NYHA class, age, gender and education were included to the model female gender (beta=0.43, p = 0.001) and delta cortisol (beta=-0.2, p = 0.049) were independent predictors of depressive symptoms and explained 25% of variance of score on the BDI (p < 0.001). Conclusions: Lower change in cortisol concentrations together with female gender were independent predictors of higher levels of depressive symptoms in CAD patients. On the other hand, CAD disease severity did not predict depressive symptoms, suggesting that depressive symptoms in CAD patients might be associated with neuro-endocrine dysfunction, but not with CAD disease severity. Also, CAD patients with moderate to severe depression had blunted thyroid axis functions and increased activity of hypothalamic–pituitary–adrenal axis when compared to patients without clinically significant depressive symptoms corresponding to findings from studies in non-CAD patients. Further longitudinal studies evaluating clinical significance of the association between depression and neuro-endocrine factors, including thyroid axis function and hypothalamic–pituitary–adrenal axis function, in patients diagnosed with CAD needed. References [1] Bunevicius R., 2009 Thyroid disorders in mental patients. Curr Opin Psychiatry 22(4), 391–395. [2] Bunevicius R., Prange A.J., Jr., 2006 Psychiatric manifestations of Graves’ hyperthyroidism: pathophysiology and treatment options CNS Drugs 20(11), 897–909. [3] Bunevicius R., Varoneckas G., Prange A.J., Jr., Hinderliter A.L., Gintauskiene V., Girdler S.S., 2006 Depression and thyroid axis function in coronary artery disease: impact of cardiac impairment and gender. Clin Cardiol 29(4), 170–174.