Depression in Cardiology and Neurology

With the combination of depression and cardiovascular diseases, the mortality rate increases. Depression is particularly severe in the case of coronary heart disease and, in particular, in case of myocardial infarction.

According to foreign studies, in the acute period of myocardial infarction, depression is recorded in 42% of patients, and among these patients are relatively young.

Re-examination of these patients showed that in the presence of symptoms of depression in the acute period of infarction, even after two years, a number of vegetative and psychopathological symptoms of depression can be stated in these patients. Among the most frequent symptoms, there is an increased level of anxiety, quick temper, a decrease in mood in the morning, sleep disturbance, a subjective feeling of loss of energy, early morning awakenings and a decrease in libido.

According to Smulevich AB (2001), “nosogenic depression” occurs in 39% of patients with a diagnosis of myocardial infarction.

Decreased mood, constant dissatisfaction with life and irritability (dysthymia) is observed in 17% of patients with manifestations of chronic circulatory failure and in 7% of those with chronic ischemic heart disease.

ON. Kornetov (1999) also identified the relationship of coronary heart disease with reactive depression, which complicates the course of cardiovascular disease and increases the percentage of mortality.

A number of studies have demonstrated that the use of antidepressants in the treatment of patients with cardiovascular disease has a positive effect on the course of the underlying disease.

For vascular depression is characterized by hereditary burden of cardiovascular disease, the course against the background of noticeable asthenia. Anxious and suspicious traits inherent in patients with vascular depression are clearly enhanced in the course of the development of the disease. The manifestation of vascular depression usually occurs after mental or physical overstrain. In the evening, some deterioration in the condition of patients is noticeable, and awakenings during the night are frequent. Asthenic, hypochondria, and anxiety-depressive symptoms, as well as cognitive disorders, are also registered in the mental status of patients with depression. Symptoms of depression often “flicker” in their severity, depending on the state of the cardiovascular system.

Among outpatients of the neurological clinic, according to S. Kirk and M. Saunders (1997), disorders of the depressive spectrum are detected in 17% of cases.

The pain of any genesis should alarm the doctor as a potential symptom of depression, its “mask”. Frequent combination of pain syndromes, especially of the chronic course, with depression is well known (J. Murray, 1997), probably based on the common pathogenesis of these conditions and, in particular, on disturbances in the serotonergic system of the brain. According to S.N. Mosolov, chronic pain syndrome (pain persisting for at least 3 months after the normal healing period) is combined with depression in 50-60% of cases. Chronic pain, in contrast to acute pain, basically has altered perception, that is, is associated with mental disorders. Long-existing pain is a marker for the appointment of antidepressants, since the effectiveness of these drugs in this case reaches 75%.

According to scientists, osteochondrosis of the thoracic and cervical spine is combined with endogenous depression (cyclothymia) in 27 and 18% of cases, respectively.

Depression of vascular genesis, occurring against the background of residual cerebral circulation disorders, is recorded in 8% of cases and in 6% of patients with neurocirculatory encephalopathy.

After a cerebral hemorrhage, depression occurs in 60% of patients, and depression in stroke is especially pronounced when the anterior regions of the brain are affected and the lesion is located in the left hemisphere.

Neurological diseases most commonly associated with depression include: Parkinson’s disease (65% of people with this disorder), epilepsy, Farah syndrome, migraine, multiple sclerosis, narcolepsy, hydrocephalus, central nervous system tumors, progressive paralysis, Wilson’s disease, some options pathologies of the hypothalamus, brain injury, complex partial seizures of temporal origin, sleep apnea. According to a number of researchers, many depressive disorders observed in neurological patients are classified as psychogenic entities. So, in particular, a similar point of view regarding multiple sclerosis is well known.

Of particular interest is the relationship between depression and dementia (including Alzheimer’s disease), as well as the diagnostic differences between these disorders, since the symptoms of the first can mimic the manifestations of the second.

Depressive states developing on the background of neurological diseases are characterized by progressive monotony. Their manifestations and a gradual increase in apathy. For depressions occurring against the background of structural brain damage, manifestations of the so-called also are typical. psychoorganic syndrome: increased fatigue and exhaustion, memory disorders, attention, tendency to constant complaints, massive autonomic disorders (sweating, palpitations, headaches, disorders of the stomach and intestines).

local_offerevent_note March 7, 2019

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