Rational Pharmacotherapy in Cardiology

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The main results of psychosomatic studies are summarized. A high incidence of mental health disorders is shown in patients with somatic diseases. They worsen the prognosis, increase the severity of the condition, make diagnosis and treatment more difficult, reduce the quality of life and work capacity, increase healthcare costs. Antidepressants decrease severity of anxiety and depression, as well as diminish frequency of somatic events and hospitalizations in patients with depression. It is important to take into account the influence of psychotropic drugs on somatic diseases and their treatment. It is important to improve the training of doctors and develop national guidelines for improving the diagnosis and treatment of patients with comorbid somatic and mental diseases.

About the Author

F. I. Belyalov
Irkutsk State Medical Academy of Postgraduate Education
Russian Federation

Farid I. Belyalov – MD, PhD, Professor, Chair of Gerontology and Geriatrics, Head of Cardiac Arrhythmia Centre

Yubileinii mkrn100,Irkutsk, 664079


1. Smulevich A.B., ed. Psychosomatic disorders in clinical practice. Мoscow: MEDpress-inform; 2016. (In Russ.) [Смулевич А.Б., ред. Психосоматические расстройства в клинической практике. М.: МЕДпресс-информ; 2016].

2. Simanenkov V.I., ed. Psychosomatic disorders in the practice of the therapist. St. Petersburg: Spetslit; 2008. (In Russ.) [Симаненков В.И., ред. Психосоматические расстройства в практике терапевта. СПб: Спецлит; 2008].

3. Belyalov F.I. Mental disorders in the practice of the therapist. 6th ed. Irkutsk: RIOIGIUV; 2013. (In Russ.) [Белялов Ф.И. Психические расстройства в практике терапевта. Изд. 6-е. Иркутск: РИОИГИУВа; 2013].

4. Levenson J.L., ed. The American Psychiatric Publishing textbook of Psychosom Medicine. 2nd ed. Washington, DC: American Psychiatric Pub; 2011.

5. Kessler R.C., Chiu W.T., Demler O., et al. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):617-27.

6. ECNP/EBC. The size and burden of mental disorders and other disorders of the brain in Europe 2010. European Neuropsychopharmacology. 2011;21:655-79.

7. King M., Nazareth I., Levy G., et al. Prevalence of common mental disorders in general practice attendees across Europe. Br J Psychiatry. 2008;192(5):362-7.

8. Grandes G., Montoya I., Arietaleanizbeaskoa M., et al. The burden of mental disorders in primary care. Eur Psychiatry. 2011;26(7):428-35.

9. Serrano-Blanco A., Palao D.J., Luciano J.V., et al. Prevalence of mental disorders in primary care: results from the diagnosis and treatment of mental disorders in primary care study (DASMAP). Social Psychiatry and Psychiatric Epidemiology. 2010;45(2):201-10.

10. Nicholson A., Kuper H., Hemingway H. Depression as an aetiologic and prognostic factor in coronary heart disease: a meta-analysis of 6362 events among 146 538 participants in 54 observational studies. Eur Heart J. 2006;27:2763-74.

11. Roest A.M., Martens E.J., de Jonge P., et al. Anxiety and Risk of Incident Coronary Heart Disease: A Meta-Analysis. J Am Coll Cardiol. 2010;56(1):38-46.

12. Edmondson D., Kronish I.M., Shaffer J.A., et al. Posttraumatic stress disorder and risk for coronary heart disease: A meta-analytic review. American Heart Journal. 2013;166(5):806-14.

13. Pietrzak R.H., Goldstein R.B., Southwick S.M., et al. Medical Comorbidity of Full and Partial Posttraumatic Stress Disorder in US Adults: Results From Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Psychosom Med. 2011;73(8):697-707.

14. Chen P.C., Chan Y.T., Chen H.F., et al. Population-Based Cohort Analyses of the Bidirectional Relationship Between Type 2 Diabetes and Depression. Diabetes Care. 2013;36(2):376-82.

15. Demakakos P., Zaninotto P., Nouwen A. Is the Association Between Depressive Symptoms and Glucose Metabolism Bidirectional? Evidence From the English Longitudinal Study of Ageing. Psychosomatic Medicine. 2014;76:555-61.

16. Levenstein S., Rosenstock S., Jacobsen R.K., Jorgensen T. Psychological stress increases risk for peptic ulcer, regardless of Helicobacter pylori infection or use of nonsteroidal anti-inflammatory drugs. Clin Gastroenterol Hepatol. 2015;13(3):498-506.e1.

17. Fond G., Loundou A., Hamdani N., et al. Anxiety and depression comorbidities in irritable bowel syndrome (IBS): a systematic review and meta-analysis. Eur Arch Psychiatry ClinNeurosci. 2014;264(8):651-60.

18. Van Oudenhove L., Crowell M.D., Drossman D.A., et al. Biopsychosocial Aspects of Functional Gastrointestinal Disorders: How Central and Environmental Processes Contribute to the Development and Expression of Functional Gastrointestinal Disorders. Gastroenterology. 2016;50:1355-67.

19. Tseng P.T., Zeng B.S., Chen Y.W., et al. A meta-analysis and systematic review of the comorbidity between irritable bowel syndrome and bipolar disorder. Medicine (Baltimore). 2016;95(33):e4617.

20. Afari N., Ahumada S.M., Wright L.J., et al. Psychological trauma and functional somatic syndromes: a systematic review and meta-analysis. Psychosom Med. 2014;76(1):2-11.

21. Lee S., Wu .J, Ma Y.L., et al. Irritable bowel syndrome is strongly associated with generalized anxiety disorder: a community study. Aliment Pharmacol Ther. 2009;30(6):643-51.

22. White K.S., Raffa S.D., Jakle K.R., et al. Morbidity of DSM-IV Axis I disorders in patients with noncardiac chest pain: Psychiatric morbidity linked with increased pain and health care utilization. J Consult Clin Psychol. 2008;76(3):422-30.

23. Eken C., Oktay C., Bacanli A., et al. Anxiety and depressive disorders in patients presenting with chest pain to the emergency department: a comparison between cardiac and non-cardiac origin. J Emerg Med. 2010;39(2):144-50.

24. Sode B.F., Dahl M., Nordestgaard B.G. Myocardial infarction and other co-morbidities in patients with chronic obstructive pulmonary disease: a Danish Nationwide study of 7.4 million individuals. Eur Heart J. 2011;32(19):2365-75.

25. Caughey G.E., Roughead E.E., Vitry A.I. et al. Comorbidity in the elderly with diabetes: Identification of areas of potential treatment conflicts.Diabetes Res ClinPract. 2010;87(3):385-93.

26. Bot M., Pouwer F., Zuidersma M. et al. Association of Coexisting Diabetes and Depression With Mortality After Myocardial Infarction. Diabetes Care. 2012;35(3):503-9.

27. Frasure-Smith N., Lesperance F. Depression and Anxiety as Predictors of 2-Year Cardi-ac Events in Patients With Stable Coronary Artery Disease. Arch Gen Psychiatry. 2008;65:62-71.

28. Ruo B., Rumsfeld J.S., Hlatky M.A. et al. Depressive symptoms and health-related quality of life: the Heart and Soul Study. JAMA. 2003; 290(2):215-21.

29. Ormel J., Petukhova M., Chatterji S. et al. Disability and treatment of specific mental and physical disorders across the world. Br J Psychiatry. 2008;192:368-75.

30. Becker A.E., Kleinman A. Mental Health and the Global Agenda. New Engl J Med. 2013;369(1): 66-73.

31. Schmitz N., Wang J., Malla A. et al. Joint Effect of Depression and Chronic Conditions on Disability: Results From a Population-based Study. Psychosom Med. 2007;69:332-8.

32. Sareen J., Cox B.J., Stein M.B., et al. Physical and Mental Comorbidity, Disability, and Suicidal Behavior Associated With Posttraumatic Stress Disorder in a Large Community Sample. Psychosom Med. 2007;69:242-8.

33. Cuijpers P., Vogelzangs N., Twisk J., et al. Comprehensive meta-analysis of excess mortality in depression in the general community versus patients with specific illnesses. Am J Psychiatry. 2014;171(4): 453-62.

34. Russ T.C., Stamatakis E., Hamer M. et al. Association between psychological distress and mortality: individual participant pooled analysis of 10 prospective cohort studies. BMJ. 2012;345.

35. Stenman M., Holzmann M.J., Sartipy U. Association between preoperative depression and long-term survival following coronary artery bypass surgery - A systematic review and meta-analysis. Int J Cardiol. 2016;222:462-6.

36. Boscarino J.A. Posttraumatic stress disorder and mortality among U.S. Army veterans 30 years after military service. Ann Epidemiol. 2006;16(4):248-56.

37. Vaccarino A.L., Sills T.L., Evans K.R. et al. Multiple Pain Complaints in Patients With Major Depressive Disorder. Psychosom Med. 2009;71(2):159-62.

38. Howren M.B., Suls J., Martin R. Depressive Symptomatology, Rather than Neuroticism, Predicts Inflated Physical Symptom Reports in Community-Residing Women. Psychosom Med. 2009;71(9): 951-7.

39. Ibatov A.D. The effect of anxiety disorders on the course of coronary heart disease. Russkiy Meditsinskiy Zhurnal. 2007;15(20):1443-6. (In Russ.) [Ибатов А.Д. Влияние тревожных расстройств на течение ишемической болезни сердца. Русский Медицинский Журнал. 2007;15(20): 1443-6].

40. Kupper N., van den Broek K.C., Widdershoven J., Denollet J. Subjectively reported symptoms in patients with persistent atrial fibrillation and emotional distress. Front Psychol. 2013;4:192.

41. Von Eisenhart Rothe A., Hutt F., Baumert J. et al. Depressed mood amplifies heart-related symptoms in persistent and paroxysmal atrial fibrillation patients: a longitudinal analysis—data from the German Competence Network on Atrial Fibrillation. Europace. 2015;17:1354-62.

42. Main J., Moss-Morris R., Booth R. et al. The use of reliever medication in asthma: the role of negative mood and symptom reports. J Asthma. 2003;40(4):357-65.

43. Ramasamy R., Hildebrandt T., O'Hea E. et al. Psychological and Social Factors That Correlate With Dyspnea in Heart Failure. Psychosomatics. 2006;47:430-4.

44. Baez K., Aiarzaguena J.M., Grandes G. et al. Understanding patient-initiated frequent attendance in primary care: a case-control study. Br J Gen Pract. 1998;48(437):1824-7.

45. Dowrick C.F., Bellon J.A., Gomez M.J. GP frequent attendance in Liverpool and Granada: the impact of depressive symptoms. Br J Gen Pract. 2000;50(454):361-5.

46. Norton J., David M., de Roquefeuil G., et al. Frequent attendance in family practice and common mental disorders in an open access health care system. Journal of Psychosomatic Research. 2012;72(6): 413-418.

47. Belanger L., Ladouceur R., Morin C.M. et al. Generalized anxiety disorder and health care use. Can Fam Physician. 2005;51:1362-3.

48. Prina A.M., Cosco T.D., Dening T., et al. The association between depressive symptoms in the community, non-psychiatric hospital admission and hospital outcomes: A systematic review. Journal of Psychosomatic Research. 2015;78(1):25-33.

49. Chwastiak L.A., Davydow D.S., McKibbin C.L. et al. The Effect of Serious Mental Illness on the Risk of Rehospitalization Among Patients With Diabetes. Psychosomatics. 2014;55(2):134-43.

50. Simpson S.H., Eurich D.T., Majumdar S.R. et al. A meta-analysis of the association between adherence to drug therapy and mortality. BMJ. 2006;333:15.

51. Calderon-Larranaga A., Diaz E., Poblador-Plou B., et al. Non-adherence to antihypertensive medication: The role of mental and physical comorbidity. International Journal of Cardiology. 2016;207:310-6.

52. Gehi A.K., Ali S., Na B., et al. Self-reported Medication Adherence and Cardiovascular Events in Patients With Stable Coronary Heart Disease: The Heart and Soul Study. Arch Intern Med. 2007;167:1798-803.

53. Gehi A., Haas D., Pipkin S., et al. Depression and Medication Adherence in Outpatients With Coronary Heart Disease: Findings From the Heart and Soul Study. Arch Intern Med. 2005;165:2508-13.

54. Rose A.J., Miller D.R., Ozonoff A., et al. Gaps in monitoring during oral anticoagulation: insights into care transitions, monitoring barriers, and medication nonadherence. Chest. 2013;143(3): 751-7.

55. Kim H.K., Park J.H., Park J.H., et al. Differences in Adherence to Antihypertensive Medication Regimens According to Psychiatric Diagnosis: Results of a Korean Population-based Study. Psychosom Med. 2010;72(1):80-7.

56. Davidson K.W., Rieckmann N., Clemow L., et al. Enhanced Depression Care for Patients With Acute Coronary Syndrome and Persistent Depressive Symptoms: Coronary Psychosocial Evaluation Studies Randomized Controlled Trial. Arch Intern Med. 2010;170(7):600-8.

57. Bogner H.R., de Vries H.F. Integration of Depression and Hypertension Treatment: A Pilot, Randomized Controlled Trial. Ann Fam Med. 2008;6:295-301.

58. Krivoy A., Balicer R.D., Feldman B. et al. Adherence to antidepressant therapy and mortality rates in ischaemic heart disease: cohort study. The British Journal of Psychiatry 2015;206:297-301.

59. Beltman M.W., Voshaar R.C., Speckens A.E. Cognitive-behavioural therapy for depression in people with a somatic disease: meta-analysis of randomised controlled trials. Br J Psychiatry. 2010;197(1): 11-9.

60. Rayner L., Price A., Evans A., et al. Antidepressants for depression in physically ill people. Cochrane Database Syst Rev. 2010;(3):CD007503.

61. Pizzi C., Rutjes A.W.S., Costa G.M., et al. Meta-analysis of Selective Serotonin Reuptake Inhibitors in Patients With Depression and Coronary Heart Disease. Am J Card. 2011;107(7):972-9.

62. Rutledge T., Redwine L.S., Linke S.E., et al. A Meta-Analysis of Mental Health Treatments and Cardiac Rehabilitation for Improving Clinical Outcomes and Depression Among Patients With Coronary Heart Disease. Psychosom Med. 2013;75(4 ):335-49.

63. Kroenke K., Bair M.J., Damush T.M., et al. Optimized Antidepressant Therapy and Pain Self-management in Primary Care Patients With Depression and Musculoskeletal Pain: A Randomized Controlled Trial. JAMA. 2009;301(20):2099-110.

64. Belyalov F.I. Treatment of diseases in conditions of comorbidity. 10th ed. Moscow: GEOTAR-Media; 2016. (In Russ.) [Белялов Ф.И. Лечение болезней в условиях коморбидности. 10-е Изд. Москва: ГЭОТАР-Медиа; 2016].

65. Glassman A.H., O'Connor C.M., Califf R.M., et al. Sertraline Treatment of Major Depression in Patients With Acute MI or Unstable Angina. JAMA. 2002;288:701-9.

66. Taylor C.B., Youngblood M.E., Catellier D. et al. Effects of Antidepressant Medication on Morbidity and Mortality in Depressed Patients After Myocardial Infarction. Arch Gen Psychiatry. 2005;62: 792-8.

67. Blumenthal J.A., Sherwood A., Babyak M.A., et al. Exercise and Pharmacological Treatment of Depressive Symptoms in Patients With Coronary Heart Disease: Results From the UPBEAT Study. J Am Coll Cardiol. 2012;60(12):1053-63.

68. Lesperance F., Frasure-Smith N., Koszycki D., et al. Effects of Citalopram and Interpersonal Psychotherapy on Depression in Patients With Coronary Artery Disease. JAMA. 2007;297:367-79.

69. Hanash J.A., Hansen B.H., Hansen J.F., et al. Cardiovascular safety of one-year escitalopram therapy in clinically nondepressed patients with acute coronary syndrome. J Cardiovasc Pharmacol. 2012;60(4):397-405.

70. Kang H.-J., Stewart R., Bae K.-Y., et al. Effects of depression screening on psychiatric outcomes in patients with acute coronary syndrome: Findings from the K-DEPACS and EsDEPACS studies. Int J Card. 2015;190:114-21.

71. van Melle J.P., de Jonge P., Honig A., et al. Effects of antidepressant treatment following myocardial infarction. Br J Psychiatry. 2007;190:460-6.

72. Estep J.D., Starling R.C., Horstmanshof D.A., et al. Risk Assessment and Comparative Effectiveness of Left Ventricular Assist Device and Medical Management in Ambulatory Heart Failure Patients: Results From the ROADMAP Study. J Am Coll Cardiol. 2015;66:1747-61.

73. Fardet L., Petersen I., Nazareth I. Suicidal behavior and severe neuropsychiatric disorders following glucocorticoid therapy in primary care. Am J Psychiatry. 2012;169(5):491-7.

74. Gjestad C., Westin A.A., Skogvoll E., Spigset O. Effect of proton pump inhibitors on the serum concentrations of the selective serotonin reuptake inhibitors citalopram, escitalopram, and sertraline. Ther Drug Monit. 2015;37(1):90-7.

75. Vamos E.P., Mucsi I., Keszei A., et al. Comorbid Depression Is Associated With Increased Healthcare Utilization and Lost Productivity in Persons With Diabetes: A Large Nationally Representative Hungarian Population Survey. Psychosom Med. 2009;71(5):501-7.

76. Sayers S.L., Hanrahan N., Kutney A., et al. Psychiatric comorbidity and greater hospitalization risk, longer length of stay, and higher hospitalization costs in older adults with heart failure. J Am Geriatr Soc. 2007;55(10):1585-91.

77. Siskind D., Araya R., Kim J. Cost-effectiveness of improved primary care treatment of depression in women in Chile. Br J Psychiatry. 2010;197(4):291-6.

78. Wang J., Patten S.B. Perceived Effectiveness of Mental Health Care Provided by Primary-Care Physicians and Mental Health Specialists. Psychosomatics. 2007;48:123-7.

79. Olfson M., Blanco C., Marcus S.C. Treatment of Adult Depression in the United States. JAMA Intern Med. 2016;176(10):1482-91.

80. Fleury M.J., Imboua A., AubО D., et al. General practitioners' management of mental disorders: A rewarding practice with considerable obstacles. BMC Fam Pract. 2012;13(1):19.

81. Gillies D., Buykx P., Parker A.G., Hetrick S.E. Consultation liaison in primary care for people with mental disorders. Cochrane Database Syst Rev. 2015;(9):CD007193.

82. Mitchell A.J., Vaze A., Rao S. Clinical diagnosis of depression in primary care: a meta-analysis. Lancet. 2009;374:609-19.

83. Vermani M., Marcus M., Katzman M.A. Rates of Detection of Mood and Anxiety Disorders in Primary Care: A Descriptive, Cross-Sectional Study. The Primary Care Companion to CNS Disorders. 2011;13(2).


For citations:

Belyalov F.I. THESES OF PSYCHOSOMATIC MEDICINE. Rational Pharmacotherapy in Cardiology. 2017;13(2):221-228. (In Russ.)

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