Depressão clínica

Aims: Access to anti-depressants, and prognosis in younger depressed men and women with acute coronary syndrome (ACS) requires further investigation. We assessed the prevalence of depression, antidepressant prescription, and the association of depression with major adverse cardiovascular events (MACE) in men and women with premature ACS.
Methods and results: 1071 ACS men and women (≤ 55 years) were recruited between January 2009 and April 2013 into GENESIS PRAXY, a multicentre prospective observational cohort study, from 24 hospitals in Canada, one in the US and one in Switzerland. Depression was measured by self-report using the Diagnostic and Statistical Manual of Mental Disorders criteria. Prescription of antidepressants at baseline and 12 months, and MACE over 12 months, were assessed using medical chart review and self-report. Depression was present in 20% of men and 32% of women. Only 1% of men and women with no antidepressants at hospital admission were prescribed antidepressants at hospital discharge. Depressed men were 3 times less likely than depressed women to be prescribed antidepressants. The determinants of antidepressants at 12 months included the presence of cardiovascular risk factors in men, and the presence of depression in women. In sex-specific Cox regressions, depressed men had a 2.57 times greater risk of MACE compared with non-depressed men (95% CI: 1.53-4.32), which difference was not seen in women (HR=0.71, 95% CI=0.28-1.81).
Conclusion: Despite a decade of sensitization, depression still needs to be better treated after ACS, especially in young men, given that depression is a potent risk factor for adverse outcomes.

The interaction between environmental factors and genetic vulnerability plays a major role in the development of mood disorders. Episodes of bipolar disorder could be considered as the outcome of the battle between stress and the individual’s ability to cope with; a fact that proposes a role of epigenetics in its pathogenesis and pathophysiology. Although the molecular studies on methylation of DNA and histone modification in cases of bipolar disorder are still inadequate but the role of stress in developing the disorder and the therapeutic efficacy of mood stabilizers in controlling its episodes highlight the potential influence of epigenetic variation in its occurrence. Limited availability of human brain tissue for conducting researches represents a great obstacle in replicating the findings on animal models of mood disorders in humans as humans do differ from animals in their response to environmental factors whether on the subcellular, cellular, organ, or individualistic levels; nevertheless some on-going research on DNA methylation seems to be very promising in settling the impact of epigenetics in the development of bipolar disorder with a potential role in empowering psychiatrists in helping their patients and controlling its episodes.

Sexual dysfunction is one of the common symptoms seen in depression. Presentations include decreased libido, erectile dysfunction, arousal difficulties and orgasm related dysfunctions. The probable causes of sexual dysfunction in such patients are complex and biological, psychological as well as psychosocial factors are likely to play an important role. Sexual dysfunction could also occur as an adverse effect of anti-depressants although it is difficult to establish whether the dysfunction is due to the illness or the medication. Awareness among professionals about sexual dysfunction is essential as it can have a profound impact in terms of relationship conflict, marital satisfaction, quality of life and compliance with treatment in patients with depression.