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25th April 2023
Psychological therapy that improves a patient’s depression could also reduce their risk of developing cardiovascular diseases in the future, according to new research.
In the first-of-its-kind study, published in the European Heart Journal, researchers retrospectively examined a cohort of 636,955 individuals who had completed the Improving Access to Psychological Therapy (IAPT) primary care programme for depression.
Individuals were free of cardiovascular disease (CVD) before entry into the IAPT and over 45 years of age, with a mean age of 55. Some 58.6% showed an improvement in their depression. Regression models then estimated the association between improvement of depression and the risk of subsequent CVD events.
In fully adjusted models, those whose depression symptoms improved after psychological therapy were 12% less likely to experience a cardiovascular event than those who did not, over an average three-year follow up.
Indeed, improving depression symptoms gave rise to a significant lowering in the risk of any new onset of CVD (hazard ratio, HR = 0.88, 95% CI 0.86 – 0.89). This was true for coronary heart disease (HR = 0.89), stroke (HR = 0.88) and all-cause mortality (HR = 0.81).
This reduction in CVD risk and risk of death from all causes was higher in those aged under 60, with 15% and 22% decreased risk respectively. Those over 60 years of age had a 5% decreased risk of developing CVD and 14% decreased risk of death from all other causes.
The authors suggest that management of depression with psychological therapies might therefore reduce the risk of subsequent CVD, but more research is needed to understand the causality of these associations.
Commenting on the study, lead author Celine El Baou, PhD candidate from UCL Psychology & Language Sciences, said: “The findings are important as they suggest that the benefits of psychological therapy may extend beyond mental health outcomes and to long-term physical health. They stress the importance of increasing access to psychological therapy to under-represented groups, for example minority ethnic groups who may be more at risk of experiencing cardiovascular disease.”
The authors also noted that previous studies have shown that people who experience depression are around 72% more likely to develop cardiovascular disease in their lifetime.
A study published earlier in 2023 also highlighted that depression and poor mental health among young adults is more likely to lead to premature CVD and suboptimal cardiovascular health. The researchers concluded that prioritising mental health might help to reduce CVD risk and improve cardiovascular health in young adults.
In 2021/22, 1.24 million referrals accessed the Improving Access to Psychological Therapies (IAPT) programme (now renamed NHS Talking Therapies for anxiety and depression) compared to 1.02 million the previous year, according to latest NHS Digital statistics.
3rd February 2023
Depression and poor mental health among young adults is more likely to lead to premature cardiovascular disease (CVD) and suboptimal cardiovascular health according to the findings of a large study of US adults by US and UK researchers.
A worrying trend over the past 20 years is the observed increase in the prevalence of recognised cardiovascular disease risk factors e.g., obesity, physical inactivity and a poor diet, among younger individuals in developed countries. Moreover, though not considered as a traditional CVD risk factor, the American Heart Association accepts that depression should be considered as a risk factor for adverse outcomes in patients with acute coronary syndrome. But to what extent does the presence of depression or even poor mental health, affect the risk of CVD among younger adults was the subject of the current study.
Researchers used data from the behavioural risk factor surveillance system which includes a nationally representative sample of non-institutionalised adults. The system assesses health-related risk behaviours and chronic health conditions, based on an annual telephone survey. The research team collected data on self-reported depression and poor mental health days (PMHDs), as well as CVD and suboptimal cardiovascular (CV) health, based on recognised risk factors, e.g., smoking, physical inactivity. In addition, self-reported PMHDs were categorised as 0, 1 – 13 or 14 to 30.
Depression and risk of premature cardiovascular disease
In total, data were collected from 593,616 with a mean age of 34.7 years (50.3% male).
The prevalence of depression was 19.6% and 2.5% for CVD. The researchers calculated that those with depression had a much higher odds of CVD compared to those without the condition (odds ratio, OR = 2.32, 95% CI 2.13 – 2.51). There was also a graded increased risk of CVD, depending on the number of reported PMHDs rising from an odds ratio of 1.48 (1 to 13 days) to 2.29 (14 to 30 days). These estimates were unaffected by gender or individual’s status (rural or urban). Suboptimal cardiovascular health was also higher among those with depression (OR = 1.79) and a similar graded relationship observed based on the number of PMHDs.
The authors concluded that based on their findings, prioritising mental health might help to reduce CVD risk and improve cardiovascular health in young adults.
Kwapong YA et al. Association of Depression and Poor Mental Health With Cardiovascular Disease and Suboptimal Cardiovascular Health Among Young Adults in the United States. J Am Heart Assoc 2023
27th May 2022
Changes in brain connectivity during treatment for depression with transcranial magnetic stimulation (TMS) and which improve symptom scores can be seen during an MRI scan. This was the key finding of a study by a team of researchers from Canada and the US.
Repetitive transcranial magnetic stimulation (TMS) is a non-invasive technique which uses magnetic pulses to influence the excitability and connection strength of the cortical neurons and has been used as a treatment modality for major depression. It involves placing an electromagnetic coil on the scalp and delivery of a brief pulsatile magnetic field that depolarises cortical neurons.
Treatment with TMS has been shown to be effective for reducing suicidal ideation and in alleviating depression. The treatment is normally applied to the left or right dorsolateral prefrontal cortex (DLPFC) although use on either side appears to be equally effective.
The mode of action for TMS remains uncertain although the effects of TMS on brain activity that can now be studied by combining it with neuroimaging methods such as functional magnetic resonance imaging.
In a 2020 study combining TMS with MRI imaging, researchers observed how the magnetic stimulation induced lasting connectivity and excitability changes such that after treatment, the DLPFC appeared better able to engage in top-down control of the amygdala.
However, the particular changes in brain connectivity affected by TMS among those with major depression are unknown.
For the present study, the team wanted to visualise these changes with MRI but also determine whether such changes led to a clinical response in patients with major depression. They recruited adults with major, treatment-resistant depression and performed an open-label trial of TMS. The team initially acquired MRI scans without TMS and compared these to scans when TMS was delivered.
The treatment was applied to the right DLPFC once daily for a period of 4 weeks. The TMS-induced changes were assessed by pairwise comparison between the MRI scan with and without TMS. Depression symptoms were assessed using the Montgomery-Asberg Depression rating scale (MADRS) which was measured at baseline and at the end of the study.
Transcranial magnetic stimulation and depression
A total of 38 patients with a mean age of 41.8 years (68% female) were included in the study.
When comparing the two scans, the researchers observed 43 edges that were changed after use of TMS with a preponderance of inter-hemispheric functional connectivity. As the changes were absent from the baseline MRI scan, these were indicative of the response to TMS and hence an index of short-term macro-scale neuroplasticity.
The observed TMS-induced changes were short-lived and the authors suggested that repeated stimulation might be necessary to induce long-lasting connectivity effects.
More importantly however, the observed were associated with an improvement in depression symptom scores, with a drop in MADRS of 10.87.
The authors concluded that the observed TMS-induced effect on connectivity may index macro-level neuroplasticity changes and which might be indicative of an individual’s response to TMS treatment.
They called for further studies to assess the generalisability of these findings and their relevance to connectivity changes after repeated TMS therapy.
Ge R et al. Predictive Value of Acute Neuroplastic Response to rTMS in Treatment Outcome in Depression: A Concurrent TMS-fMRI Trial Am J Psychiatry 2022