Vol 9, No 1- Neuropsychiatry and Cardiovascular Disease
Past issues Contributors How to publish Contributions and comments Home
 
I n  t h i s  i s s u e... The themes and the titles of the articles, as well as the choice of authors for this issue of Dialogues in Clinical Neuroscience, were initiated by Prof Manfred Ackenheil a few months before his sudden death in the summer of 2006. The obituary written by Dr Jean-Paul Macher attests to the human and scientific qualities of Prof Manfred Ack- enheil. Here, in the name of the members of the Editori- al Board of Dialogues in Clinical Neuroscience, we acknowledge with sadness that Prof Manfred Ackenheil will forever be absent from the group of colleagues and friends who collaborate on this journal. It is with much sadness that we have written this short text, because it is he who should have written it. This issue of Dialogues in Clinical Neuroscienceis devot- ed to the relationship between depression and cardiovas- cular disease (CVD), in particular coronary heart disease (CHD). Twenty-five years ago, CVD was not considered of great importance among primary-care treatments aimed at improving the health of populations in poor countries; nor was depression. This situation has changed, to the point where CVD and depression might represent the two major health problems throughout the world; CVD might even occur earlier in life and have more severe medical consequences in poor countries. The fact that these dis- eases are often comorbid raises several questions, addressed here. The State of the artpaper by Alexander Glassman (p 9) provides a historical overview of the epidemiological and clinical studies on the association of depression and CVD, in particular CHD and myocardial infarction. These stud- ies have consistently demonstrated the increased risk of cardiac diseases or cardiac death in persons suffering from depression, and Prof Glassman discusses a series of pos- sible mechanisms to explain the association of coronary disease and depression. He also addresses the question of whether the outcome of CVD can be influenced by treat- ing depression, and he presents results from preliminary studies that suggest a positive answer to this question. In her Basic researchpaper on common genetic factors for depression and cardiovascular disease (p 19), Brigitta Bondy explores a series of hypotheses about potential genetic changes in CVD and depression. She mentions genes coding for the serotonergic system, for the immune system and inflammation, and for the angiotensin-con- verting enzyme, as well as other genes. Her review is cen- tered on genetic changes that lead to biological changes that might be common to the mechanisms of CVD and depression. Several of the results illustrate her own work and that of her collaborators, exploring why these disor- ders occur in association. Jeff C. Huffman and Theodore A. Stern have written a Pharmacological aspectsreview (p 29) on the psycho- logical and psychiatric changes that can occur on treat- ment with cardiovascular drugs. They address both the adverse and beneficial effects of several medications, such as b-blockers, angiotensin-converting enzyme inhibitors, angiotensin II blockers, calcium channel blockers, diuret- ics, digoxin, several antihypertensives and antiarrhythmics, lipid-lowering drugs, and other drugs. According to their analysis, several facts are less well established than usual- ly considered by many physicians, for example the risk of inducing depression with b-blockers or even reserpine, the antidepressant effects of angiotensin-converting enzyme, and the antimanic effects of verapamil. Psychotropic med- ications are known to have several modes of action that are common to cardiovascular medications, and thus rec- ommendations are needed because of side effects on the heart. This review is a reminder that cardiovascular med- ications influence the central nervous system through sev- eral mechanisms that might prove useful in psychiatry, but that certainly can lead to neuropsychiatric side effects. The second Pharmacological aspectspaper (p 47) con- cerns a domain that is often cited as a candidate for the probable beneficial effect of several recent antidepres- sants on hemostasis. Demian Halperin and Guido Reber first summarize the complex biochemical events of coag- ulation in a manner that should be understandable to psy- chiatrists who have lost the notes they took during their medical studies. Then, the authors show which stages of coagulation are altered by antidepressants. The effect of several recent antidepressants on hemostasis might be favorable for the evolution of CVDs; this effect can cer- tainly lead to cases of abnormal bleeding. The authors mention that studies with different types of methodolo- gies lead to somewhat different findings as to the influ- ence of antidepressants on coagulation. The first Clinical researchpaper (p 61) is on the relation- ship between hypertension and cognitive deficits. In this type of comorbidity, the CVD changes might be the prima- ry cause of neuropsychiatric changes. Christophe Tzourio