Having heart disease multiplies the risk of depression. Among chronically ill people, such as heart patients, the incidence of 'living pain' is 30%: up to 6 times higher than the 5-7% of the general population. The good news, however, is that even those with heart problems can safely take antidepressant drugs, which do not represent a danger neither for heart attack survivors, nor for patients with functional chest pain, nor for those with coronary artery disease. Furthermore, in all these cases, treatments for depression work just as well as in people without cardiac disorders. And they are safe, although a little less effective, even in patients with low back pain or traumatic brain injury. A large systematic review and meta-analysis published in 'Jama Psychiatry' sheds light on the alleged risks of antidepressants for those who also suffer from physical illnesses.
The results of the work, conducted by the Charité University of Berlin and the University of Aarhus in Denmark, were discussed at the XXV National Congress of the Society of NeuroPsychoPharmacology (Sinpf), dedicated to the theme 'The neurosciences of tomorrow: neuropsychopharmacology towards precision and the personalization of care. “Depression is the most frequent mental pathology in Italy, with over 3 million people suffering from depressive symptoms and a further increasing prevalence following the Covid-19 pandemic”, says Claudio Mencacci, Sinpf co-president and director emeritus of Neurosciences at the Fatebenefratelli-Sacco hospital in Milan. “Numerous international studies – he adds – have shown that among sufferers of widespread chronic pathologies, such as diabetes or heart failure, the incidence of depression in Italy is 30%. A very high percentage if compared to that found among the population in general, which varies between 5% and 7%”. 25 percentage points more, 6 times as much.
But the relationship between chronic pathologies and depression is a 'two-way' relationship: “Not only does a chronically ill person have a greater risk of falling into depression than the rest of the population”, specifies Mencacci. “Even those who are depressed have a greater chance of falling ill with chronic pathologies. For this reason – underlines the psychiatrist – it is essential to have a clear understanding of the treatment options for patients with depression and other comorbidities”.
Although antidepressants are the first-line treatment for any manifestation of major depressive disorder, neuropsychopharmacologists remind us, most studies aimed at evaluating the safety and effectiveness of these drugs exclude patients with other comorbidities. Therefore, the use of antidepressants in the treatment of depression in patients with other illnesses is poorly understood. “This new study fills an important gap – says Matteo Balestrieri, co-president of Sinpf, director of the Psychiatric Clinic of the University Health Authority of Udine – Based on 176 systematic reviews that took into consideration 43 diseases and 52 meta-analyses regarding 27 different conditions medical conditions, the work concludes that antidepressants are safe and effective even for patients suffering from depression with underlying conditions such as cancer, cardiac and metabolic diseases, as well as rheumatological and neurological disorders.”
A crucial data for those suffering from both depression and physical pathologies, but also fundamental for directing clinical practice. “The quality of life is often seriously compromised, especially by depression – observes Mencacci – We also know that the course of physical illness is worse in patients who also suffer from depression. Therefore treating these patients with antidepressants, in addition to other therapeutic measures, can really be of great help.”
However, there remains the need to pay attention to any contraindications and interactions with other drugs taken by patients, the Sinpf experts point out. “Fortunately, however – concludes Balestrieri – today there are many antidepressants with different mechanisms of action. Therefore, almost always, there is at least one drug suitable for treating depression for each patient, regardless of medical history. It is very important, of course , the correct management of the therapy, once started. As for any type of patient”.
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