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

冠心病抑郁患者的疲劳、快感缺乏和心脏预后标志物

• 批准号: 10171891
• 负责人: ROBERT M CARNEY
• 金额: $ 74.5万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-01 至 2025-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10171891
• 关键词: Aftercare; Anhedonia; Antidepressive Agents; Behavioral Medicine; Biological Markers; Blood; C-reactive protein; Cardiac; Cardiology; Cardiovascular system; Chronic; Clinical; Clinical Trials; Cognitive Therapy; Coronary heart disease; DSM-V; Depressed mood; Development; Disease Resistance; Disease remission; Disease-Free Survival; Electrocardiogram; Enrollment; Equipment; Equipment and supply inventories; Evaluation; Event; Exclusion Criteria; Fatigue; Future; Goals; Heart Diseases; Heart Rate; Home; Hour; Hydrocortisone; Hyperthyroidism; Instruction; Intervention; Interview; Lipids; Major Depressive Disorder; Measurement; Measures; Mediating; Medical; Mental Depression; Modeling; Monitor; Morbidity - disease rate; Participant; Patient Self-Report; Patients; Physical activity; Plasma; Prognostic Marker; Randomized Clinical Trials; Randomized Controlled Trials; Research; Residual state; Risk; Risk Marker; Sampling; Schedule; Sleep; Sleep Apnea Syndromes; Sleep Disorders; Stressful Event; Structure; Sympathetic Nervous System; Symptoms; Thyroid Diseases; Thyroid Gland; Thyroid Hormones; Thyroxine; Time; Treatment outcome; Universities; Washington; Wrist; actigraphy; aggressive therapy; circadian; cofactor; common symptom; depressed patient; depressive symptoms; effective intervention; effective therapy; efficacy testing; heart rate variability; high risk; improved; medical schools; mortality; mortality risk; perceived stress; poor sleep; programs; recruit; response; saliva sample; sex; sleep quality; standard care; symptom treatment; treatment response

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.

抑郁症与冠心病的心脏病发病率和死亡率风险增加有关 （冠心病）。尽管存在针对重度抑郁症的安全且适度有效的治疗方法，但只有约 30% 的患者 曾经达到完全缓解。患有抑郁症状且对治疗无反应的先心病患者 与抑郁症状有反应的人相比，心脏病发病率和死亡率的风险较高 治疗。快感缺乏和疲劳是治疗后最常见的症状之一 抑郁的冠心病患者和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志物，包括甲状腺的正常高水平 无激素甲状腺素 (FT4)、夜间心率变异性低、昼夜节律心率迟缓和睡眠质量差 质量预测抑郁症治疗反应以及治疗后疲劳和快感缺乏症状。这是 尚不清楚为什么这些风险标记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、感知水平高 压力、体力活动水平低、睡眠紊乱和隐匿性亚临床甲状腺疾病等 最合理的解释。任何或所有这些因素都可以解释风险标记之间的关系 以及残余疲劳和快感缺乏，所有这些都是潜在可改变的，因此是未来的可能目标 临床试验。拟议研究的目的是确定这些风险标记的可修改相关性 以及患有冠心病的抑郁症患者的疲劳和快感缺乏。研究参与者将从 华盛顿大学医学院的心脏病学实践。潜在符合资格的患者将 安排进行结构化临床访谈。 BDI-II 得分 >14 并符合 DSM-5 标准的人 对于重度抑郁症，不会纳入排除标准。参与者将在行为测试中接受评估 华盛顿大学医学院医学中心。评估将在 禁食 12 小时后的早晨，首先进行抽血以获取甲状腺指标、血脂、血浆 皮质醇、C 反应蛋白和其他生物标志物。参与者将配备动态心电图监护仪 和腕部活动记录仪，完成一系列自我报告清单，并获得收集指示 在家中采集唾液样本用于皮质醇测量。心电图监护仪和体动记录仪将佩戴 48 小时 连续两个工作日测量心电图标记、活动水平和睡眠参数。唾液 两天内每天采集三次样本：醒来时、下午三点左右和之前 就寝时间。参与者将在归还样品和设备后获得时间补偿。这项研究 将确定辅助干预措施的潜在目标，以增强传统抑郁症治疗的效果， 从而有助于为随机临床试验奠定基础，以确定是否可以治疗抑郁症 冠心病患者可以改善抑郁症和无事件生存期。