THE ROLE OF ANTIDEPRESSANTS IN CARDIOLOGY PRACTICE
Cardiovascular diseases (CVD) are one of the most common diseases that reduce the ability to work and lead to disability and it is known that the prevalence of depression in patients with CVD ranges from 18 to 60%. Also, CVD can lead to depressive disorders or exacerbate their course, increasing the risk of suicide.
The relationship between CVD and mood disorders is multifactorial and complex. It can be assumed that there are at least three categories of causal relationships: depression is a direct consequence of CVD; depression is a psychological reaction to an illness; depression is a consequence of side effects of therapy for the underlying disease (for example, taking β- blockers).
It has long been known that in patients with coronary artery disease, even without clinical manifestations of depression, the use of antidepressants improves prognosis and survival, which may be due to both its somatized nature and the effect of drugs on the pathogenesis of CVD.
Since different antidepressants have a different chemical structure, as well as a mechanism of action, the side effects of drugs from different groups are different.
Amitriptyline was for a long time the sole medication for the management of depression in cardiological patients despite a large number of side effects. It was substituted by the safe and cardiologically neutral sertraline, a selective serotonin re-uptake inhibitor. Presently, the results of agomelatine therapy of cardiovascular diseases and accompanying depressions arise great interest.
Cardiovascular and gastrointestinal complications, sexual dysfunction, excessive sedation, and weight gain can sometimes prompt early discontinuation of some antidepressants. However, the absence of cardiovascular and gastrointestinal complications, neutrality in relation to body weight, sexual function are the hallmarks of agomelatine. With the accumulation of sufficient positive experience, this drug can take its rightful place in the practice of treating depression in patients with CVD.
Conclusion. When using antidepressants in cardiology practice, the most important conditions are good tolerability, absence of toxic effect, minimal interaction with other drugs, and relative safety in case of overdose. Knowledge of the risk factors, mechanisms of development and clinical manifestations of depression in patients with CVD and the use of modern antidepressants allow the cardiologist not only to effectively deal with depression, alleviate the suffering of the patient, prevent suicide, improve the prognosis of the underlying disease and reduce mortality, but also improve the quality of life and maintain full social adaptation of the patient after discharge.
(https://mjssh.academicjournal.io/index.php/mjssh ISSN: 2795-4846)
SCAC 07/22 CNS 001 MPAD
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