Magazine article Clinical Psychiatry News
Heart Risk Factors Hurt Depression Tx. (Another Puzzle Piece)
SAN FRANCISCO -- The total burden of cardiovascular risk factors in a patient with major depressive disorder is an independent predictor of lack of response to antidepressant therapy with fluoxetine, Dr. Dan V Iosifescu reported at the annual meeting of the American Psychiatric Association.
This finding adds to a growing body of evidence illuminating the association between depression and cardiovascular disease. Numerous prior studies have documented high rates of depression in cardiovascular patients and have shown that the presence of depression in these patients is associated with worse cardiovascular outcomes.
This new study examined the relationship from the opposite direction--and concluded that cardiovascular risk factors adversely affect the outcome of treatment for depression, explained Dr. Iosifescu, director of neurophysiology studies in the depression clinical and research program at Massachusetts General Hospital, Boston.
He reported on 348 patients with major depressive disorder who participated in an 8-week open-label trial involving fixeddose fluoxetine therapy at 20 mg/day The standard Framingham cardiovascular risk factors were assessed at baseline. With a mean age of 40 years, this was a young and healthy group free of known coronary disease.
The mean baseline score on the Hamilton Rating Scale for Depression (HAM-D) was 19.6, falling to 10.8 after 8 weeks of therapy However, final HAM-D scores varied by cardiovascular risk status. Patients with three of more cardiovascular risk factors had an average final score of 12, while those with no more than one risk factor had an average final HAM-D below 10.
In antidepressant clinical trials, a response is typically defined as a 50% or greater reduction in HAM-D score, while remission is considered to be a final HAM-D score of 7 or less. Among patients with no cardiovascular risk factors or with one risk factor in this trial, 63% responded to fluoxetine and 57% went into remission. …