Magazine article Clinical Psychiatry News

CVD May Be Linked to Depression in Lupus

Magazine article Clinical Psychiatry News

CVD May Be Linked to Depression in Lupus

Article excerpt

Philadelphia patients with lupus have a high prevalence of depression, which may be linked to the cardiovascular disease that's also highly prevalent in lupus patients.

Cardiovascular disease and cardiovascular risk "may precipitate development of depression in patients with lupus," Laura Julian, Ph.D., said at the annual meeting of the American College of Rheumatology. It's also possible that depression in patients with systemic lupus erythematosus (SLE) exacerbates cardiovascular disease by making patients poorly compliant with treatment. "The relationship between cardiovascular disease and depression [in lupus patients] may be bidirectional," she said.

Because of this apparent interrelationship, physicians who care for SLE patients should regularly screen them for depression and treat it when diagnosed. Physicians should also be diligent about screening for and treating cardiovascular disease risks in lupus patients, said Dr. Julian, a neuropsychologist at the University of California, San Francisco.

"Our working hypothesis is that accumulation of vascular disease in specific white-matter regions of the brain might precipitate development of depression. In lupus patients there is a very high risk of cardiovascular outcomes, so we think this is reasonable," she said in an interview. This etiology has been called vascular depression.

Evidence supporting the occurrence of vascular depression in SLE patients came from following patients who were enrolled in the Lupus Outcomes Study, which enrolled patients with SLE at the University of California, San Francisco. Dr. Julian and her associates collected data from 725 lupus patients who were followed for more than 5 years. More than 90% of the patients were women, and average age at entry to the study was 51.

At entry and regularly during follow-up, the patients were assessed for depression by having them complete the CES-D (Center for Epidemiology Studies-Depression) scale, a commonly used, self-report, 20-question survey. People who scored 23 or higher on the CES-D were considered to have probable depression. …

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