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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 7 of 7. This is the beginning of the thread.
Posted by Phillipa on November 30, 2008, at 18:53:59
How does norepenephrine play into this. If it's not good why do we have meds with it in them. Tired and confused. Phillipa
Lack of Exercise and Other Bad Behaviors Explain the Link Between Depression and CVD, Study Suggests
from Heartwire a professional news service of WebMD
November 25, 2008 (San Francisco, California) Researchers who set out to pick apart the bonds that link depression and cardiovascular disease (CVD) say that health behaviors and not complex biological processes largely account for the increased risk of cardiac events in people with depression [1]. Physical inactivity, in particular, likely accounts for the bulk of the risk, Dr Mary A Whooley (VA Medical Center, San Francisco, CA) and colleagues write in the November 26, 2008 issue of the Journal of the American Medical Association.The Heart and Soul Study looked at over 1000 people with stable coronary heart disease, followed for almost five years, measuring depressive symptoms at baseline in relation to subsequent heart failure, MI, stroke, transient ischemic attack, or death.
Whooley explained to heartwire that while depression has long been known to increase the risk of heart disease, the candidate mechanisms had not previously been. "There's been a lot of interest in physiological consequences of depression, like elevated norepinephrine, elevated cortisol, low heart-rate variability, and platelet activation, but there hasn't been as much focus on the behavioral mediators, although they certainly have been suggested by previous studies. Surprisingly, we found that the fancy physiological mediators really were not explaining the association and that it seemed to be all about health behaviors."
According to Whooley, depressed patients were less likely to take their medications as prescribed, less likely to exercise, and more likely to smoke. "And after you accounted for those health behaviors, the association between depression and CVD went away. So we concluded that link between depression and heart disease is largely explained by these health behaviors."
Good, But Challenging News
As with other studies, Whooley et al's analysis showed a clear link between depression and cardiovascular events. Of the 341 events that occurred over the 4876 person-years of follow-up, the age-adjusted rate of events was 10% among the 199 individuals with depressive symptoms and only 6.7% among the 818 subjects without depressive symptoms (p=0.002). That translated into a 31% increased risk of cardiovascular events in depressed subjects, after adjustment for comorbidities and disease severity.
If biological mediators were factored into the analysis--things like use of antidepressant drugs, heart-rate variability, levels of serotonin and omega-3s, or 24-hour excretion of norepinephrine and cortisol--the effect size for depressive symptoms on CV events did not substantially change. However, when behavioral factors such as adherence to medication, smoking status, and most strikingly physical activity were factored in, the association between depressive symptoms and cardiovascular events was no longer statistically significant.
"This is good news in that these are modifiable and it's cheap to get people to exercise and to take their medications; the more challenging news is that it's very hard to change behaviors," Whooley commented. "We can't just give people a medication that will magically lower their norepinephrine or cortisol, we have to start behavioral interventions, and those are notoriously difficult."
Whooley also acknowledged that it doesn't matter whether patients first grew depressed due to lack of physical exercise or stopped exercising when they became depressed. "Very likely it's a vicious cycle and the association is bidirectional," she said. "In our opinion, it doesn't really matter whether it's the chicken or the egg because the bottom line is the same--if you increase exercise in these patients, you're going to reduce their risk of heart disease. But the thing to remember about depressed patients is that they are that much less motivated to do things, so it takes extra effort to get them to exercise, take their medications, and stop smoking."
It doesn't really matter whether it's the chicken or the egg because the bottom line is the same--if you increase exercise in these patients you're going to reduce their risk of heart disease.
The Heart and Soul results may help explain the failure of a number of high-profile trials looking at whether use of antidepressant medication in depressed subjects could improve cardiovascular outcomes. Whooley et al's results "open up another potential intervention," she said. Indeed, the Understanding Prognostic Benefits of Exercise and Antidepressant Therapy (UPBEAT) study, still under way, is comparing antidepressants with an exercise intervention in improving cardiovascular risk factors. "It won't be looking at whether we can actually prevent events, but rather changes in inflammation and things like that. But it is the next step in the right direction," Whooley said.Her group is also continuing to investigate the association between physical activity level and heart disease in depressed subjects, with the ultimate aim of developing an intervention that might be able to reduce the risk of events in people with cardiovascular disease.
Whooley MA, de Jonge P, Vittinghoff E, et al. Depressive symptoms, health behaviors, and risk of cardiovascular events in patients with coronary heart disease. JAMA 2008; 300:2379-2388.The complete contents of Heartwire, a professional news service of WebMD, can be found at www.theheart.org, a Web site for cardiovascular healthcare professionals.
Posted by Phillipa on November 30, 2008, at 18:56:34
In reply to Excercise,Smoking, Depression, Meds,Cortisol, posted by Phillipa on November 30, 2008, at 18:53:59
I don't get the lower norepenphrine? Phillipa
Posted by JadeKelly on December 1, 2008, at 0:15:18
In reply to Re: Excercise,Smoking, Depression, Meds,Cortisol » Phillipa, posted by Phillipa on November 30, 2008, at 18:56:34
> I don't get the lower norepenphrine? Phillipa
Too much norepenphrine causes high blood pressure, I believe.
~Jade
Posted by Phillipa on December 1, 2008, at 19:07:54
In reply to Re: Excercise,Smoking, Depression, Meds,Cortisol, posted by JadeKelly on December 1, 2008, at 0:15:18
probably as cymbalta and effexor cause high blood pressure in some. Phillipa
Posted by desolationrower on December 2, 2008, at 0:01:32
In reply to Re: Excercise,Smoking, Depression, Meds,Cortisol » Phillipa, posted by Phillipa on November 30, 2008, at 18:56:34
> I don't get the lower norepenphrine? Phillipa
Peripheral sympathetic system activation occurs because of/along with stress - the LC firing and feeling adrenalin, blood pressure rising, etc. Chronically, its complicated by different depression types, i think severe melancholia is high NA, whereas atypical depression type is more of a low NA. I think NRIs actually decrease norepinepherine metabolism and reduce lc firing rate but maintain a constant level and availibility.
-d/r
Posted by JadeKelly on December 2, 2008, at 17:32:32
In reply to Re: Excercise,Smoking, Depression, Meds,Cortisol, posted by desolationrower on December 2, 2008, at 0:01:32
> > I don't get the lower norepenphrine? Phillipa
>
> Peripheral sympathetic system activation occurs because of/along with stress - the LC firing and feeling adrenalin, blood pressure rising, etc. Chronically, its complicated by different depression types, i think severe melancholia is high NA, whereas atypical depression type is more of a low NA. I think NRIs actually decrease norepinepherine metabolism and reduce lc firing rate but maintain a constant level and availibility.
>
> -d/rHi d/r, you still thinking of adding (I think it was nortriptyline) to your Parnate? If you did, hows that going? I'm not far enough along I don't think.
Btw-thnks for helpin out "that guy"/Shawn. Or maybe you've just got my back should I screw up? haha. Either way, thanks. He's trying hard to get well.
~Jade
Posted by desolationrower on December 2, 2008, at 18:57:57
In reply to Re: Excercise,Smoking, Depression, Meds,Cortisol » desolationrower, posted by JadeKelly on December 2, 2008, at 17:32:32
Yeah i need to see my doctor again, he had to cancel the last appointment and i have been visiting my parents the last week. It will be one thing i'll talk to himj about.
-d/r
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