Pharmacological treatment and prevention of cardiovascular diseases and depression comorbidity: Understanding epidemiological, clinical trial evidence, and the biological underpinnings

Abstract

Depression and cardiovascular disease (CVD) are currently of major concern to public health and will be increasingly so in the future. These two disorders are closely interconnected both clinically and biologically. Understanding this interconnection is important to appreciating current and potential treatment and prevention platforms. There are a number of plausible biological models which may link depression and CVD together. Key models include a dysfunctional hypothalamic- pituitary-adrenal (HPA) axis, chronic elevations in pro- infl ammatory cytokines, increased sympathetic tone, platelet dysfunction leading to a pro-thrombotic state, as well as reductions in arterial vessel elasticity and endothelial dysfunction. The aim of this chapter is to review the epidemiological, clinical trial, and biological literature exploring the role of pharmacological treatment and prevention of depression and CVD. Antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), do appear useful in the treatment of comorbid depression and CVD, and they appear to play a role in the prevention of adverse cardiac events. The role of serotonin-noradrenaline reuptake inhibitors (SNRIs) is poorly understood and should be treated with caution. Anti- infl ammatory therapies show promise in the treatment of depression; however, there is a paucity of clinical trial data on the role of anti-infl ammatory therapies for the prevention of adverse cardiac events. An emerging body of research has now begun to explore the effect of pharmacological agents on infl ammation, HPA axis dysfunction, increased sympathetic tone, and vascular and platelet dysfunction. This research should be continued to better understand the underlying mechanism of effect of pharmacological agents in comorbid depression and CVD