Effects of Sertraline on Circulating Markers of Oxidative Stress in Depressed Patients With Chronic Heart Failure: A Pilot Study

doi:10.1016/j.cardfail.2011.05.004

Journal of Cardiac Failure

Volume 17, Issue 9, September 2011, Pages 748-754

https://doi.org/10.1016/j.cardfail.2011.05.004 Get rights and content

Abstract

Background

Depression is a common comorbid condition in patients with chronic heart failure (CHF). This pilot study investigated the plasma levels of oxidative stress markers in depressed CHF patients as well as the effects of antidepressant treatment with sertraline on these markers in the same patient population.

Methods and Results

Patients with positive depression screening [Beck Depression Inventory (BDI) score >10 and/or Zung Self-Rating Depression Scale >40] underwent a psychiatric interview. Patients newly diagnosed as depressed received pharmacologic treatment with sertraline for 3 months (arm A) and were compared with those who did not comply with the antidepressant treatment (arm B). Markers of oxidative stress [malondialdehyde (MDA) and protein carbonyls (PC)], and nitrosative stress [nitrotyrosine (NT)] were assessed at baseline and 3 months later. Fifty-two out of 254 screened hospitalized CHF patients were diagnosed as depressed. Depressed patients had significantly higher levels of MDA compared with age- and gender-matched nondepressed patients (n = 40; 3.2 ± 2.0 vs 2.8 ± 3.8 μmol/L; P = .02). Twenty-eight patients received sertraline (arm A), and 24 refused to receive antidepressant treatment on the top of optimal heart failure treatment (arm B). Although baseline levels of MDA and PC in arm A and arm B did not differ significantly (P > .05), arm A patients demonstrated a significant reduction in MDA (F = 4.657; P = .037) and arm B patients demonstrated no change after 3 months. Regarding the examined scores, arm A patients had a decrease in BDI score (28 ± 11 vs 21 ± 13; P = .008), and arm B patients had no change in BDI score at follow-up (P > .05). Arm A had an increase in 6-minute walking distance (291 ± 110 vs 361 ± 87 m; P = .02), and arm B experienced no change (P > .05).

Conclusions

Increased oxidative stress may play a critical role in the pathophysiology of depression in CHF. Treatment with sertraline improves depressive symptoms and reduces plasma markers of oxidative stress in depressed CHF patients.

Section snippets

Study Population and Design

The study population consisted of 52 CHF patients suffering from depression. Our study cohort were selected among 254 consecutive patients hospitalized for symptoms of heart failure secondary to ischemic or idiopathic dilated cardiomyopathy, screened for depressive symptomatology. All patients were asked to complete 2 psychiatric evaluation screening instruments, namely, the Beck Depression Inventory (BDI) and the Zung Self-Rating Depression Scale (Zung SDS). Those with a positive score

Results

Fifty-two out of 254 screened hospitalized CHF patients were diagnosed as depressed (∼20%). Depressed patients (arm A and B) had significantly higher levels of MDA compared with 40 age- and gender-matched nondepressed CHF patients with LVEF <40% (3.2 ± 2.0 vs 2.8 ± 3.8 μmol/L; P = .02; Fig. 2). No difference was found between PC and NT levels in the depressed group compared with the nondepressed group [1.5 ± 0.7 vs 1.4 ± 0.8 nmol/mg protein (P = .47) for PC and 1.5 (193.9) vs 2.1 (83.8) nmol/L (

Discussion

Depression is a common feature in CHF patients. In the present study, ∼20% of patient population was positively screened for depressive symptomatology, a percentage that is in accordance with the international bibliography.1, 19, 20 Not only does depression affect quality of life, but it also exerts deleterious effects on cardiac and vascular function and aggravates the syndrome of CHF per se. The recent OPTIMIZE-HF (Organized Program to Initiate Life-Saving Treatment in Hospitalized Patients

Conclusion

In conclusion, this pilot study showed that depression is associated with higher levels of plasma MDA in patients with CHF. Oxidative status could express a common causative pathway underlying depression and heart failure, partly explaining why these 2 syndromes so often coexist. Depression worsens CHF patients’ prognosis and quality of life, and it is important that timely diagnosis is made and appropriate therapeutic measures taken. This pilot logistic and mechanistic study showed that

Disclosure

None.

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Overall, 216 acute stroke patients were consecutively recruited and followed up for 1 month. Blood specimens were collected within 24 h after admission and measured for the following oxidative stress biomarkers: malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GSH-PX). All enrolled patients were divided into the PSD group or the non-PSD group according to an assessment of clinical depression. One hundred normal control subjects were also recruited.
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Neopterin: Levels of plasma neopterin are increased in depressed patients [31–35] — particularly in patients suffering from melancholia [33,36]. Malondialdehyde (MDA): MDA levels are increased in depressed patients [31] and a similar relationship has been found in depressed patients suffering from chronic heart failure [37]. Isoprostanes: Levels of isoprostanes are elevated in patients suffering from depression, as demonstrated by higher urinary concentrations of 8-iso-PGF2α [38,39] and of a β-oxidant metabolite of 8-iso-PGF2α.
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Clinical InvestigationEffects of Sertraline on Circulating Markers of Oxidative Stress in Depressed Patients With Chronic Heart Failure: A Pilot Study

Abstract

Background

Methods and Results

Conclusions

Section snippets

Study Population and Design

Results

Discussion

Conclusion

Disclosure

Biol Psychiatry

Free Radic Biol Med

Clin Psychol Rev

Am J Cardiol

Methods Enzymol

Atherosclerosis

Eur J Heart Fail

Am J Med

Prog Neur Biol Psych

Eur J Pharmacol

Prog Neuropsychopharmacol Biol Psychiatry

J Am Coll Cardiol

J Card Fail

Int J Cardiol

Neuropsychopharmacology

J Chromatogr B Analyt Technol Biomed Life Sci

J Am Coll Cardiol

Predictors of the onset of depressive symptoms in patients with heart failure

J Am Coll Cardiol

Comparison of circulating proinflammatory cytokines and soluble apoptosis mediators in patients with chronic heart failure with versus without symptoms of depression

Am J Cardiol

Clinical Investigation
Effects of Sertraline on Circulating Markers of Oxidative Stress in Depressed Patients With Chronic Heart Failure: A Pilot Study