Antidepressant drugs do not represent a danger for people with heart disease – for whom the incidence of depression reaches 30% compared to 5-7% of the general population – nor for those who have had a myocardial infarction, nor for those suffering from functional chest pain and neither for those suffering from coronary heart disease. For these patients, pharmacological treatment against depression is as effective as it is for those who do not have any cardiac problems. They are also safe, although somewhat less effective, for patients with low back pain or traumatic brain injury.
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A large systematic review and meta-analysis published in the journal JAMA Psychiatry has shed light once and for all on the unfounded fear that antidepressants are not an indicated therapy for those with one or more physical illnesses. The results of the research, conducted by the Charité University of Berlin and the University of Aarhus in Denmark, were discussed at the XXV National Congress of the Society of NeuroPsychoPharmacology (Sinpf), dedicated to “The neurosciences of tomorrow: neuropsychopharmacology towards precision and the personalization of care”.
The Depression
“Depression is the most frequent mental pathology in Italy, with over 3 million people suffering from depressive symptoms and a further increasing prevalence following the Covid-19 pandemic – he explains Claudio Mencacci, Co-President of Sinpf and director emeritus of Neurosciences at the Fatebenefratelli-Sacco Hospital in Milan – . Numerous international studies have shown that among sufferers of widespread chronic pathologies, such as diabetes or heart failure, the incidence of depression in Italy is 30%. A very high percentage if compared to that found among the general population, which varies between 5 and 7%”.
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Chronic pathologies
But the relationship between chronic pathologies and depression is bidirectional. “Not only does a chronically ill person have a greater risk of falling into depression compared to the rest of the population – specifies Mencacci -. Even those who are depressed have a greater possibility of falling ill with chronic pathologies. This is why it is essential to have a clear understanding of what the options are of treatment for patients with depression and other comorbidities”.
Although antidepressants are the first-line treatment for any manifestation of major depressive disorder, most studies aimed at evaluating the safety and effectiveness of these drugs exclude patients with other comorbidities. Therefore, the use of antidepressants in the treatment of depression in patients with other diseases is poorly understood.
“This new study fills an important gap – he explains Matteo Balestrieri, Co-President of SINPF, director of the Psychiatric Clinic of the University Health Authority of Udine – . Based on 176 systematic reviews that took into consideration 43 diseases and 52 meta-analyses regarding 27 different medical conditions, the work concludes that antidepressants are safe and effective even for patients suffering from depression with underlying pathologies, such as cancer, cardiac and metabolic diseases, as well as rheumatological and neurological disorders”.
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This is good news for people with depression and physical health problems, and is very relevant to clinical practice. “The quality of life is often seriously compromised, especially by depression – explains Mencacci -. We also know that the course of physical illness is worse in patients who also suffer from depression. Therefore, treating these patients with antidepressants in addition to other therapeutic measures can really be of great help.”
Interaction with other drugs
However, there remains the need to pay attention to any contraindications and interactions with other drugs taken by patients. “Fortunately, however, today there are many antidepressants with different mechanisms of action – concludes Balestrieri -. Therefore, almost always, there is at least one drug suitable for treating depression for each patient, regardless of medical history. Naturally, it is very important correct management of the therapy, once started. As for any type of patient”.