سکته‌ی قلبی و افسردگی

نوع مقاله : Review Article

نویسندگان

1 دانشیار، گروه قلب و عروق، دانشکده‌ی پزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران

2 استادیار، گروه روان‌پزشکی، انیسیتو روان‌پزشکی تهران، دانشگاه علوم پزشکی تهران، تهران، ایران

چکیده

مقدمه: علایم افسردگی در بیماران پس از بروز سکته‌ی قلبی (MI با Myocardial Infarction) بسیار شایع است و می‌تواند اثرات منفی بر پیش‌آگهی بیماری داشته باشد. افسردگی در 35 تا 50 درصد موارد بیماران مبتلا به MI گزارش شده است. افسردگی به عنوان یک عامل خطرساز مستقل برای بروز MI، مرگ و میر و عوارض بعدی پس از MI و کاهش کیفیت زندگی در مبتلایان به MI شناخته می‌شود. ارتباط بین افسردگی و MI یک ارتباط دو طرفه است. مکانیسم‌های واسطه‌ای مطرح در ایجاد رابطه‌ی بین افسردگی پس از MI و افزایش خطر مرگ و میر شامل مکانیسم‌های رفتاری و مکانیسم‌های زیست‌شناختی هستند. وجود آریتمی، تغییر در تعادل حیاتی، التهاب، مکانیسم‌های عصبی-هورمونی و لخته پذیری از جمله مکانیسم‌های زیست‌شناختی هستند. ممکن است که ترکیبی از این دو دسته مکانیسم موجب افزایش خطر مرگ و میر در این بیماران شود.مطالعات همه‌گیر شناسی رابطه‌ی بین افسردگی و افزایش خطر ابتلای بعدی به بیماری قلبی عروقی، MI و مرگ قلبی را نشان داده است. تأثیر منفی افسردگی بر پیش‌آگهی بیماری قلبی با درمان صحیح قابل پیش‌گیری است. روش‌های درمانی متعددی برای درمان افسردگی پس از MI به کار گرفته شده است که شامل بازتوانی قلبی، حمایت اجتماعی، درمان شناختی- رفتاری و داروهای ضد افسردگی می‌شود. توصیه می‌شود در درمان دارویی افسردگی پس از MI از داروهای سه حلقوی به دلیل اثرات نامطلوب آنها اجتناب شود. در صورتی که داروهای ضد افسردگی SSRI با فاصله‌ی کمی‌ پس از MI شروع شود، عوارض جانبی مهمی نخواهند داشت.

کلیدواژه‌ها

عنوان مقاله [English]

Myocardial Infarction and Depression

نویسندگان [English]

  • Hamid Saneei 1
  • Ali Baghbanian 2
1 Associate Professor, Department of Cardiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
2 Assistant Professor, Department of Psychiatry, Institute of Psychiatry, Tehran University of Medical Sciences, Tehran,Iran.
چکیده [English]

Background: Depressive symptoms are common among post myocardial infarction (MI) patients and may cause negative impacts on cardiac prognosis. 35 to 45% of MI patients report depression. Depression is an independent risk factor for MI and post MI mortality and decreased quality of life in post MI patients.The link between depression and MI is bidirectional. Behavioral and biological mechanisms were proposed as the plausible mechanisms between post-MI depression and increased risk of mortality. Biological mechanisms include arrhythmias, hemostasis, immunological pathway, neuroendocrinological mechanism and increased thrombosis. The combination of these mechanisms is likely to involve in increasing the risk of mortality.Epidemiological studies have shown the link between depression and increased risk for development of cardiovascular disease, MI and cardiac mortality. The adverse impact of depression on prognosis of heart disease is preventable with the right treatment. A number of therapeutic approaches have been advocated for post-MI depression, including cardiac rehabilitation, social support, cognitive behavior therapy, and antidepressants. Because of adverse effects, it is recommended to avoid prescription of tricyclics for treating post MI depression. If SSRIs are prescribed shortly after MI the important side effects caused by them will be low.    

کلیدواژه‌ها [English]

  • Myocardial Infarction
  • Depression
  • Mortality
  • Treatment of depression
  • Behavioral mechanisms
  • Biological mechanisms

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مجله دانشکده پزشکی اصفهان
دوره 29، شماره 127 - شماره پیاپی 127
فروردین و اردیبهشت 1390
صفحه 102-114

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سابقه مقاله

  • تاریخ دریافت: 01 آذر 1389
  • تاریخ بازنگری: 11 آبان 1403
  • تاریخ پذیرش: 17 فروردین 1401

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