Appreciating the links between heart failure and depression

心力衰竭 萧条(经济学) 背景(考古学) 生物心理社会模型 静载荷 医学 心情 变向性 生活质量(医疗保健) 心理学 重症监护医学 心脏病学 精神科 老年学 古生物学 护理部 经济 宏观经济学 生物
作者
Hugo Critchley,Ekaterina Yarovova,Sandra Howell,Stuart D. Rosen
出处
期刊:QJM: An International Journal of Medicine [Oxford University Press]
卷期号:117 (1): 3-8 被引量:2
标识
DOI:10.1093/qjmed/hcad213
摘要

Summary Depression and heart failure frequently occur together, symptoms overlap and the prognosis is worsened. Both conditions share biopsychosocial risk factors and are accompanied by behavioural/lifestyle, neurohormonal, inflammatory and autonomic changes that are implicated aetiologically. Depression has been conceptualized as a decompensated response to allostatic overload, wherein adaptive psychological, behavioural and physiological responses to chronic and/or severe stress, become unsustainable. Heart failure can similarly be viewed as a decompensated response to circulatory overload, wherein adaptive functional (neurohormonal effects on circulation, inotropic effects on heart) and structural (myocardial remodelling) changes, become unsustainable. It has been argued that the disengaged state of depression can initially be protective, limiting an individual’s exposure to external challenges, such that full recovery is often possible. In contrast, heart failure, once past a tipping-point, can progress relentlessly. Here, we consider the bidirectional interactions between depression and heart failure. Targeted treatment of depression in the context of heart failure may improve quality of life, yet overall benefits on mortality remain elusive. However, effective treatment of heart failure typically enhances function and improves key psychological and behavioural determinants of low mood. Prospectively, research that examines the mechanistic associations between depression and heart failure offers fresh opportunity to optimize personalized management in the advent of newer interventions for both conditions.
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