Fatigue, Anhedonia and Cardiac Prognostic Markers in Depressed Patients with Coronary Heart Disease

抑郁与冠心病心脏病发病率和死亡率的增加有关 (CHD)。尽管存在安全和适度有效的治疗重度抑郁症的方法，但只有大约30%的患者 永远不会达到完全缓解。有抑郁症状但治疗无效的冠心病患者 与那些抑郁症状有反应的人相比，心脏病发病率和死亡率的高风险 治疗。快感缺乏和疲劳是治疗后最常见的症状之一 无论是抑郁的冠心病患者还是健康状况良好的精神病患者。在最近的一项研究中，我们发现 心血管发病率和死亡率的几个风险标记物，包括甲状腺正常高水平 无激素甲状腺激素(FT4)，夜间心率变异性低，昼夜心率迟钝，睡眠不佳 质量预测抑郁症的治疗反应和治疗后疲劳和快感缺乏的症状。它是 不清楚为什么这些风险标记物与残留的快感缺乏和疲劳有关。皮质醇水平升高， 慢性交感神经系统激活，心率迷走神经调节减少，高水平知觉 压力、体力活动不足、睡眠紊乱和隐匿性的亚临床甲状腺疾病都是原因之一。 最合理的解释。这些因素中的任何一个或全部可以解释风险标记之间的关系 以及残留的疲劳和快感缺乏，所有这些都是潜在的可修改的，因此可能是未来的目标 临床试验。拟议研究的目的是确定这些风险标记物的可修改相关性。 冠心病抑郁患者的疲劳和快感缺乏。研究参与者将从以下地点招募 在华盛顿大学医学院从事心脏病学实践。可能符合条件的患者将是 安排了一次有组织的临床访谈。那些在BDI-II上获得14分并符合DSM-5标准的人 对于严重的抑郁症，不会有排除标准。参与者将在行为研究所接受评估 华盛顿大学医学院医学中心。评估将在 早上禁食12小时后，将开始抽血，获取甲状腺面板、血脂谱、血浆 皮质醇、C反应蛋白和其他生物标志物。参赛者将配备一个动态心电监护仪 和手腕活动记录仪，完成一组自我报告清单，并接受收集指示 在家中采集唾液样本进行皮质醇测量。心电监护仪和活动记录仪将佩戴48小时 连续两个工作日测量心电标记物、活动水平和睡眠参数。唾液 每天采集三次样品，为期两天：醒来时、下午三点左右和之前 该上床睡觉了。参赛者将在归还样品和设备后获得时间补偿。本研究 将确定辅助干预的潜在目标，以加强传统的抑郁症治疗和 从而有助于为一项随机临床试验奠定基础，以确定治疗抑郁症是否 冠心病患者可以改善抑郁和无事件生存率。

Depression is associated with an increased risk of cardiac morbidity and mortality in coronary heart disease (CHD). Although safe and modestly effective treatments for major depression exist, only about 30% of patients ever achieve full remission. CHD patients with depression symptoms that do not respond to treatment are at high risk for cardiac morbidity and mortality compared to those whose depression symptoms respond to treatment. Anhedonia and fatigue are among the most common symptoms to remain following treatment in both depressed CHD patients and in medically well psychiatric patients. In a recent study, we found that several risk markers of cardiovascular morbidity and mortality including a high normal level of the thyroid hormone free thyroxine (FT4), low nocturnal heart rate variability, blunted circadian heart rate, and poor sleep quality predict depression treatment response and post-treatment symptoms of fatigue and anhedonia. It is unclear why these risk markers are associated with residual anhedonia and fatigue. Elevated cortisol levels, chronic sympathetic nervous system activation, reduced vagal modulation of HR, high levels of perceived stress, low level of physical activity, disordered sleep, and occult subclinical thyroid diseases are among the most plausible explanations. Any or all of these factors may explain the relationship between the risk markers and residual fatigue and anhedonia, and all are potentially modifiable and thus possible targets for future clinical trials. The purpose of the proposed research is to identify modifiable correlates of these risk markers and of fatigue and anhedonia in depressed patients with CHD. Study participants will be recruited from cardiology practices at Washington University School of Medicine. Potentially eligible patients will be scheduled for a structured clinical interview. Those who score >14 on the BDI-II and meet the DSM-5 criteria for major depression and no exclusion criteria will be enrolled. Participants will be evaluated at the Behavioral Medicine Center at Washington University School of Medicine. The evaluation will be performed in the morning after a 12-hour fast, and will start with a blood draw to obtain a thyroid panel, lipid profile, plasma cortisol, C-reactive protein, and other biomarkers. Participants will be fitted with an ambulatory ECG monitor and a wrist actigraph, complete a battery of self-report inventories, and be given instructions for collecting saliva samples at home for cortisol measurement. The ECG monitor and actigraph will be worn for 48 hours on two consecutive weekdays to measure the ECG markers, activity levels, and sleep parameters. Saliva samples will be obtained three times per day for two days: upon awakening, mid-afternoon, and before bedtime. Participants will be compensated for their time upon return of the samples and equipment. This study will identify potential targets for adjunctive interventions to augment traditional depression treatments and thereby help to lay the groundwork for a randomized clinical trial to determine whether treating depression in patients with CHD can improve both depression and event-free survival.