Depression treatment and risk for cardiovascular disease

描述(申请人提供)：马修·怀特，博士，马萨诸塞大学医学院临床心理学家。他的长期目标是阐明抑郁症和心血管疾病(CVD)之间的联系机制，并确定影响身心健康的抑郁症治疗方法。抑郁症与心血管疾病的发病风险密切相关，但抑郁症治疗对心血管疾病发病的影响尚不清楚。这表明有必要调查各种可用的抑郁症治疗的效果，并更彻底地了解抑郁症治疗可能影响心血管疾病风险的作用机制。大多数试图通过抑郁症治疗来影响心血管疾病的研究都是二级预防研究。这项建议将为怀特博士提供所需的培训和指导，以发展流行病学和临床试验方法方面的专业知识，调查抑郁症治疗对初级心血管疾病风险(首次心血管疾病事件)的影响。建议进行两项研究，以调查两种类型的抑郁症治疗(选择性5-羟色胺再摄取抑制剂：SSRIs和认知行为疗法：CBT)对心血管疾病风险的影响。自主神经平衡(通过心率变异性测量；HRV)与抑郁症相关，也是心血管疾病的既定危险因素；自主神经平衡将是这些研究中感兴趣的主要心血管疾病机制。这项建议的研究1将有助于为临床建议提供信息 SSRI治疗通过根据预测性风险评分(Framingham Risk Score：FRS)确定SSRI是否对心血管疾病风险较高或较低的患者的主要心血管疾病发病率产生不同影响。在此之后，心率变异性(HRV)将作为SSRI和CVD关联的中介进行检查。研究2是一项先导性临床试验，将通过循证心理治疗来减少抑郁症状，以观察在缺乏药物治疗的情况下减轻抑郁症状对心率变异性的影响。这些研究是相互关联的，因为它们都通过独立关注抗抑郁药物或心理治疗来调查抑郁症治疗对自主神经平衡的影响。怀特博士之前在心理生理学方面的研究是对培训计划的补充，培训计划将为怀特博士提供有关抑郁症、抑郁症治疗、心血管生理学、自主神经失衡的额外知识，以及使用流行病学和临床试验方法研究主要心血管疾病风险所需的经验和专业知识。他的长期研究计划将侧重于了解抑郁症治疗对初级心血管疾病风险和危险因素的影响，以便根据生理和心理评估以及心理和生理治疗目标为抑郁症治疗提供临床指南。

DESCRIPTION (provided by applicant): Matthew Whited, PhD is a clinical psychologist at the University of Massachusetts Medical School. His long- term goal is to elucidate the mechanisms of the association between depression and cardiovascular disease (CVD) and to identify depression treatments that influence both physical and mental long-term health. Depression is strongly and consistently associated with risk for CVD onset, but the influence of depression treatment on CVD onset is poorly understood. This indicates a need to investigate the effects of the various available depression treatments, and to more thoroughly understand the mechanisms of action by which depression treatments could influence CVD risk. The majority of studies that seek to influence CVD through depression treatment are studies of secondary prevention. This proposal will provide Dr. Whited with the training and mentorship needed to develop expertise in both epidemiological and clinical trials approaches that investigate the effects of depression treatments on primary CVD risk (first CVD event). Two studies are proposed to investigate the effects of each of two types of depression treatment (Selective Serotonin Reuptake Inhibitors: SSRIs and Cognitive Behavioral Therapy: CBT) on CVD risk. Autonomic balance (measured by heart rate variability; HRV) is associated with depression, and is also an established risk factor for CVD; autonomic balance will be the main CVD mechanism of interest in these studies. Study 1 of this proposal will help inform clinical recommendations of SSRI treatment by determining if SSRIs differentially influence primary CVD incidence in patients who are at higher or lower risk for CVD according to a predictive risk score (Framingham Risk Score: FRS). Following this, Heart Rate Variability (HRV) will be examined as a mediator of the SSRI and CVD association. Study 2 is a pilot clinical trial that will reduce depressive symptoms via an evidence-based psychotherapy to observe the effect of depression symptom reduction on HRV in the absence of pharmacotherapy. These studies are linked in that they both investigate the effects of depression treatment on autonomic balance by independently focusing on either antidepressant medications or psychotherapy. Dr. Whited's prior research in psychophysiology complements the training plan, which will provide Dr. Whited with additional knowledge in depression, its treatment, cardiovascular physiology, autonomic imbalance, along with the experience and expertise necessary to study primary CVD risk using epidemiological and clinical trials methodology. His long-term program of research will focus on understanding the influence of depression treatment on primary CVD risk and risk factors in order to inform clinical guidelines for depression treatment based on both physiological and psychological assessment and psychological and physiological treatment targets.