Brief report
Reversal of increased arterial stiffness in severely depressed women after 6-week antidepressant treatment

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Abstract

Background

Increased arterial stiffness (AS) might be one significant acute mediator of the well-attested association between female depression and cardiovascular disease.

Methods

We tested this hypothesis in an inpatient sample of 20 drug-free women undergoing a new clinically severe major depressive episode of recent onset with an adequately matched mentally healthy control group. Patients' clinical (Hamilton Depression Rating Scale) and vascular (Pulse–Wave–Velocity, PWV) assessments were performed both before the initiation and after the completion of their six-week antidepressant treatment.

Results

Although initially patients exhibited significantly higher PWV values than controls, this was decreased and reached comparable levels to controls after treatment completion. Moreover, full-responders exhibited significantly greater vascular improvement than their partial-responders counterparts and the magnitude of their amelioration was strongly associated with the magnitude of their clinical improvement.

Limitations

Our sample-size was small and patients' follow-up short.

Conclusions

Our findings provide support to the hypothesis that current severe major depressive episode in women leads acutely to aggravation of arterial stiffness, reversible however upon timely and effective antidepressant treatment.

Introduction

Major depression (MD) constitutes one major risk factor of cardiovascular diseases (CVD), especially in women (Moeller-Leimkuehler, 2007, Van der Kooy et al., 2007). Higher depression levels in women without a history of CVD almost double their relative risk for fatal and non-fatal CVD within a 10–15 year follow-up (Haukkala et al., 2009). Moreover, past history of depression and/or concurrent elevated depressive symptoms in women almost triple their risk of CVD within a 6-year follow-up (Vaccarino et al., 2008).

Increased arterial stiffness (AS) might be an important mediator of the strong association between MD in women and CVD. Indeed, increased AS constitutes an independent risk-factor of CVD in both normotensive individuals and hypertensive patients (Boutouyrie et al., 2002, Laurent et al., 2003, Dijk et al., 2004). Moreover, Pulse–Wave–Velocity (PWV), a reliable and valid index of regional AS (Nichols and O'Rourke, 2005), has been found strongly correlated with severity of concurrent depressive symptoms in one large cross-sectional epidemiological study of old-age people (Tiemeier et al., 2003). However, the design of this study did not permit the assessment neither of the directionality of this positive correlation, nor of its pace (i.e., its acute vs. chronic escalation).

Our aim in the present study was to test the hypothesis that a current clinically severe major depressive episode (MDE) of recent onset in women acutely leads to increased AS. On the grounds of this hypothesis we predicted that patients would exhibit increased AS compared to adequately matched healthy female controls. Moreover, we predicted that patients' AS would improve after antidepressive treatment.

Section snippets

Patients

Twenty consecutive female inpatients with a life-time DSM-IV-TR (APA, 2000) diagnosis of major depressive disorder (MDD) undergoing a new MDE of recent onset (≤ 30 days) and of high clinical severity (Hamilton Depression Rating Scale-17 items score ≥ 24) participated in the study. Their diagnosis was confirmed through the administration of the Structured Clinical interview for DSM-IV disorders, clinician version (First et al., 1997), as well as through an extensive clinical and laboratory work-up

Results

Table 2 displays the summary results of patients' clinical and vascular assessments both before the initiation and after the completion of their inpatient antidepressant treatment, as well as those of healthy controls' vascular assessment.

Initially, patients exhibited significantly higher PWV values than their healthy control counterparts (z =  2.761, p  .006). Under treatment, patients' HDRS scores and PWV values decreased significantly (z =  3.639, p  .00, and z =  2.114, p  .03 respectively). Cohen's

Discussion

We assessed AS in a sample of 20 drug-free female inpatients with MDD undergoing a new clinically severe MDE of recent onset both before the initiation and after the completion of their 6-week antidepressant treatment, as well as in an adequately matched control-group of 20 mentally healthy females. Our study was designed to test for the first time the hypothesis that current MDE in females leads acutely to increased AS. Our main findings were that patients' exhibited higher AS than normal

Role of the funding source

Nothing declared.

Conflict of interest

No conflict declared.

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