Koronare Herzkrankheit und Depression: klinische Bilder und Konzepte

Die Psychokardiologie ist – neben ihren wissenschaftlichen Aspekten – vor allem ein neuartiges klinisches Versorgungsgebiet, das den Leidensdruck von Patienten mit kardiovaskulären Erkrankungen in Form von Erschöpfung, Ängsten, Depression und Stresserleben diagnostiziert und mit psychosomatischen Therapieangeboten lindern kann. Es gilt, den wechelseitigen Zusammenhang zwischen seelischem Leid und körperlicher Erkrankung zu erkennen und mit geeigneten Mitteln zu behandeln.

Kernaussagen

• Die Depression mit ihren Facetten „vitale Erschöpfung“, „somatisierte Depression“ und die „Typ-D-Persönlichkeit“ tragen sowohl zum Auftreten einer KHK als auch zu einem komplizierteren Verlauf der KHK bei.

• Das Screening, die klinische Diagnosestellung und die Therapie einer Depression stellen somit in der Kardiologie eine besondere Herausforderung dar.

• Ein systematisches Screening sollte mit dem PHQ-2 oder mit Kurzfragebögen durchgeführt werden. Im ärztlichen Gespräch besteht die Möglichkeit, mit gezielten Fragen nach depressiven Symptomen zu screenen.

• Ärztlicherseits ist es wichtig, den Patienten durch eine offene Kommunikation zu ermutigen, über sich und sein Befinden zu sprechen.

• Die Therapie erstreckt sich von der initialen empathischen Begegnung im Rahmen der psychokardiologischen bzw. psychosomatischen Grundversorgung über ein multimodales kollaboratives Therapiesetting („Collaborative Care“) bis hin zur ambulanten Psychotherapie.

• Bei schwerem Leidensdruck und starker Beeinträchtigung sollte primär eine stationäre psychosomatische-psychokardiologische Komplexbehandlung oder ggf. psychiatrische Behandlung erfolgen.

• Bei schwerer Depression kann die Gabe eines Antidepressivums – bevorzugt eines SSRI – in Betracht gezogen werden.

Schlüsselwörter

koronare Herzkrankheit - Depression - vitale Erschöpfung - Typ-D-Persönlichkeit - Psychokardiologie

Publication History

Article published online:
18 December 2023

• Literatur

• 1 Herrmann-Lingen C, Albus C, Tiltscher G. Psychokardiologie. 3. Berlin, Heidelberg: Springer; 2020
• 2 Engel GL. The Need for a New Medical Model: A Challenge for Biomedicine. Science 1977; 196: 129-136 DOI: 10.1126/science.847460. (PMID: 847460)
• 3 Appels A, Mulder P. Excess fatigue as a precursor of myocardial infarction. Eur Heart J 1988; 9: 758-764 DOI: 10.1093/eurheartj/9.7.758. (PMID: 3169045)
• 4 Schloss MJ, Swirski FK, Nahrendorf M. Modifiable Cardiovascular Risk, Hematopoiesis, and Innate Immunity. Circ Res 2020; 126: 1242-1259 DOI: 10.1161/CIRCRESAHA.120.315936. (PMID: 32324501)
• 5 Gerber Y, Benyamini Y, Goldbourt U. et al. Neighborhood socioeconomic context and long-term survival after myocardial infarction. Circulation 2010; 121: 375-383 DOI: 10.1161/CIRCULATIONAHA.109.882555. (PMID: 20065165)
• 6 Ladwig K-H, Lukaschek K. Ist Stress am Arbeitsplatz ein Thema für den kardiologischen Alltag? Evidenz, Erkennung und Therapie aversiver Stressbedingungen im Arbeitsumfeld. Aktuel Kard 2023; 12: 120-125
• 7 Eaker ED, Sullivan LM, Kelly-Hayes M. et al. Marital status, marital strain, and risk of coronary heart disease or total mortality: The Framingham Offspring Study. Psychosom Med 2007; 69: 509-513 DOI: 10.1097/PSY.0b013e3180f62357. (PMID: 17634565)
• 8 Vaccarino V, Goldberg J, Rooks C. et al. Post-traumatic stress disorder and incidence of coronary heart disease: A twin study. J Am Coll Cardiol 2013; 62: 970-978 DOI: 10.1016/j.jacc.2013.04.085. (PMID: 23810885)
• 9 Chida Y, Steptoe A. The Association of Anger and Hostility With Future Coronary Heart Disease. A Meta-Analytic Review of Prospective Evidence. J Am Coll Cardiol 2009; 53: 936-946 DOI: 10.1016/j.jacc.2008.11.044. (PMID: 19281923)
• 10 Bundesärztekammer (BÄK), Kassenärztliche Bundesvereinigung (KBV), Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). S3-Leitlinie Nationale VersorgungsLeitlinie Unipolare Depression. AWMF-Register-Nr. nvl-005. 2022 Accessed July 13, 2023 at: https://register.awmf.org/assets/guidelines/nvl-005l_S3_Unipolare-Depression_2023–07.pdf
• 11 Albus C, Waller C, Fritzsche K. et al. Bedeutung von psychosozialen Faktoren in der Kardiologie – Update 2018. Kardiologe 2018; 12: 312-331
• 12 Jha MK, Qamar A, Vaduganathan M. et al. Screening and Management of Depression in Patients With Cardiovascular Disease: JACC State-of-the-Art Review. J Am Coll Cardiol 2019; 73: 1827-1845 DOI: 10.1016/j.jacc.2019.01.041. (PMID: 30975301)
• 13 Levis B, Sun Y, He C. et al. Accuracy of the PHQ-2 Alone and in Combination with the PHQ-9 for Screening to Detect Major Depression: Systematic Review and Meta-analysis. JAMA 2020; 323: 2290-2300 DOI: 10.1001/jama.2020.6504. (PMID: 32515813)
• 14 Freedland KE, Carney RM, Lenze EJ, Rich MW. Psychiatric and psychosocial aspects of cardiovascular disease. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, Braunwald E. Braunwald’s Heart Disease. 12. Philadelphia: Elsevier; 2022
• 15 Levis B, Benedetti A, Thombs BD. Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: Individual participant data meta-analysis. BMJ 2019; 365: l1476 DOI: 10.1136/bmj.l1476. (PMID: 30967483)
• 16 Berger M, van Calker D, Brakemeier E-L, Schramm E. Affektive Störungen. In: Berger M. Psychische Erkrankungen. 6. München: Elsevier; 2019: 363-444
• 17 Libby P, Buring JE, Badimon L. et al. Atherosclerosis. Nat Rev Dis Primers 2019; 5: 1-18 DOI: 10.1038/s41572-019-0106-z. (PMID: 31420554)
• 18 van der Kooy KG, van Hout HPJ, van Marwijk HWJ. et al. Differences in heart rate variability between depressed and non-depressed elderly. Int J Geriatr Psychiatry 2006; 21: 147-150 DOI: 10.1002/gps.1439. (PMID: 16416460)
• 19 Koertge J, Al-Khalili F, Ahnve S. et al. Cortisol and vital exhaustion in relation to significant coronary artery stenosis in middle-aged women with acute coronary syndrome. Psychoneuroendocrinology 2002; 27: 893-906 DOI: 10.1016/s0306-4530(02)00002-1. (PMID: 12383451)
• 20 Hinterdobler J, Schott SS, Jin H. et al. Acute mental stress drives vascular inflammation and promotes plaque destabilization in mouse atherosclerosis. Eur Heart J 2021; 42: 4077-4088 DOI: 10.1093/eurheartj/ehab371. (PMID: 34279021)
• 21 Vaccarino V, Johnson BD, Sheps DS. et al. Depression, inflammation, and incident cardiovascular disease in women with suspected coronary ischemia: the National Heart, Lung, and Blood Institute-sponsored WISE Study. J Am Coll Cardiol 2017; 50: 2044-2050 DOI: 10.1016/j.jacc.2007.07.069. (PMID: 18021871)
• 22 Mohanta SK, Peng L, Li Y. et al. Neuroimmune cardiovascular interfaces control atherosclerosis. Nature 2022; 605: 152-159 DOI: 10.1038/s41586-022-04673-6. (PMID: 35477759)
• 23 Simon MS, Schiweck C, Arteaga-Henríquez G. et al. Monocyte mitochondrial dysfunction, inflammaging, and inflammatory pyroptosis in major depression. Prog Neuropsychopharmacol Biol Psychiatry 2021; 111: 110391 DOI: 10.1016/j.pnpbp.2021.110391. (PMID: 34171401)
• 24 Jiang W, Samad Z, Boyle S. et al. Prevalence and Clinical Characteristics of Mental Stress–Induced Myocardial Ischemia in Patients With Coronary Heart Disease. Psych Med 2013; 75: 822-831
• 25 Lichtman JH, Froelicher ES, Blumenthal JA. et al. Depression as a risk factor for poor prognosis among patients with acute coronary syndrome: systematic review and recommendations: a scientific statement from the American Heart Association. Circulation 2014; 129: 1350-1369 DOI: 10.1161/CIR.0000000000000019. (PMID: 24566200)
• 26 Ladwig KH, Emeny RT, Häfner S. et al. Depression: Ein nach wie vor unterschätztes Risiko für die Entwicklung und Progression der koronaren Herzerkrankung. Bundesgesundheitsbl 2011; 54: 59-65
• 27 Cuijpers P, Vogelzangs N, Twisk J. et al. Differential mortality rate in major and subthreshold depression: meta-anaylsis of studies that measured both. Br J Psychiatry 2013; 202: 22-27
• 28 Meijer A, Conradi HJ, Bos EH. et al. Prognostic association of depression following myocardial infarction with mortality and cardiovascular events: A meta-analysis of 25 years of research. Gen Hosp Psychiatry 2011; 33: 203-216
• 29 Mesa-Vieira C, Grolimund J, von Känel R. et al. Psychosocial risk factors in cardiac rehabilitation: Time to screen beyond anxiety and depression. Glob Heart 2021; 16: 16 DOI: 10.5334/gh.896. (PMID: 33833940)
• 30 Denollet J. Standard assessment of negative affectivity, social inhibition, and type D personality. Psychosom Med 2005; 67: 89-97 DOI: 10.1097/01.psy.0000149256.81953.49. (PMID: 15673629)
• 31 Vroege EM, Zuidersma M, De Jonge P. Vital exhaustion and somatic depression: the same underlying construct in patients with myocardial infarction?. Psychosom Med 2012; 74: 446-451 DOI: 10.1097/PSY.0b013e31825a7194. (PMID: 22685238)
• 32 Kupper N, Denollet J. Type D personality as a prognostic factor in heart disease: Assessment and mediating mechanisms. J Pers Assess 2007; 89: 265-276 DOI: 10.1080/00223890701629797. (PMID: 18001227)
• 33 Hausteiner C, Klupsch D, Emeny R. et al. Clustering of negative affectivity and social inhibition in the community: Prevalence of type D personality as a cardiovascular risk marker. Psychosom Med 2010; 72: 163-171 DOI: 10.1097/PSY.0b013e3181cb8bae. (PMID: 20100886)
• 34 Denollet J, Stanislas U, Stroobant N. et al. Personality as independent predictor of long-term mortality in patients with coronary heart disease. Lancet 1996; 347: 417-421 DOI: 10.1016/s0140-6736(96)90007-0. (PMID: 8618481)
• 35 Mols F, Denollet J. Type D personality among noncardiovascular patient populations: a systematic review. Gen Hosp Psychiatry 2010; 32: 66-72 DOI: 10.1016/j.genhosppsych.2009.09.010. (PMID: 20114130)
• 36 Parkes CM, Benjamin B, Fitzgerald RG. Broken heart: a statistical study of increased mortality amongs widowers. Br Med J 1969; 1: 740-743 DOI: 10.1136/bmj.1.5646.740. (PMID: 5769860)
• 37 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: 2763-2774 DOI: 10.1093/eurheartj/ehl338. (PMID: 17082208)
• 38 Harshfield EL, Pennells L, Schwartz JE. et al. Association Between Depressive Symptoms and Incident Cardiovascular Diseases. JAMA 2020; 324: 2396-2405 DOI: 10.1001/jama.2020.23068. (PMID: 33320224)
• 39 El Baou C, Desai R, Cooper C. et al. Psychological therapies for depression and cardiovascular risk: evidence from national healthcare records in England. Eur Heart J 2023; 44: 1650-1662 DOI: 10.1093/eurheartj/ehad188. (PMID: 37072130)
• 40 Schnohr P, Marott JL, Kristensen TS. et al. Ranking of psychosocial and traditional risk factors by importance for coronary heart disease: The Copenhagen City Heart Study. Eur Heart J 2015; 36: 1385-1393 DOI: 10.1093/eurheartj/ehv027. (PMID: 25681607)
• 41 De Miranda Azevedo R, Roest AM, Hoen PW. et al. Cognitive/affective and somatic/affective symptoms of depression in patients with heart disease and their association with cardiovascular prognosis: a meta-analysis. Psychol Med 2014; 44: 2689-2703 DOI: 10.1017/S0033291714000063. (PMID: 24467963)
• 42 Frestad D, Prescott E. Vital exhaustion and coronary heart disease risk: A systematic review and meta-analysis. Psychosom Med 2017; 79: 260-272 DOI: 10.1097/PSY.0000000000000423. (PMID: 27902666)
• 43 Thombs BD, Markham S, Rice DB. et al. Does depression screening in primary care improve mental health outcomes?. BMJ 2021; 374: n1661 DOI: 10.1136/bmj.n1661. (PMID: 34281908)
• 44 Herrmann-Lingen C, Beutel ME, Bosbach A. et al. A Stepwise Psychotherapy Intervention for Reducing Risk in Coronary Artery Disease (SPIRR-CAD): Results of an Observer-Blinded, Multicenter, Randomized Trial in Depressed Patients With Coronary Artery Disease. Psychosom Med 2016; 78: 704-715
• 45 Visseren FLJ, MacH F, Smulders YM. et al. ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 2021; 42: 3227-3337 DOI: 10.1093/eurheartj/ehab484. (PMID: 34458905)
• 46 Richards SH, Anderson L, Jenkinson CE. et al. Psychological interventions for coronary heart disease: Cochrane systematic review and meta-analysis. Eur J Prev Cardiol 2018; 25: 247-259 DOI: 10.1177/2047487317739978. (PMID: 29212370)
• 47 Terada T, Cotie LM, Tulloch H. et al. Sustained Effects of Different Exercise Modalities on Physical and Mental Health in Patients With Coronary Artery Disease: A Randomized Clinical Trial. Can J Cardiol 2022; 38: 1235-1243 DOI: 10.1016/j.cjca.2022.03.017. (PMID: 35961757)
• 48 Reed JL, Terada T, Cotie LM. et al. The effects of high-intensity interval training, Nordic walking, and moderate-to-vigorous intensity continuous training on functional capacity, depression and quality of life in patients with coronary artery disease enrolled in cardiac rehabilitation: A randomized controlled trial (CRX study). Prog Cardiovas Dis 2022; 70: 73-83 DOI: 10.1016/j.pcad.2021.07.002. (PMID: 34245777)
• 49 Kleinschmidt J, Köllner V. Herz und Psyche in Bewegung bringen. Psychotherapie im Dialog 2021; 22: 82-86
• 50 Albus C, Herrmann-Lingen C, Jensen K. et al. Additional effects of psychological interventions on subjective and objective outcomes compared with exercise-based cardiac rehabilitation alone in patients with cardiovascular disease: A systematic review and meta-analysis. Eur J Prev Cardiol 2019; 26: 1035-1049 DOI: 10.1177/2047487319832393. (PMID: 30857429)
• 51 Glassman AH, O’Connor CM, Califf RM. et al. Sertraline treatment of major depression in patients with acute MI or unstable angina. JAMA 2002; 288: 701-709 DOI: 10.1001/jama.288.6.701. (PMID: 12169073)
• 52 Tully PJ, Ang SY, Lee EJL. et al. Psychological and pharmacological interventions for depression in patients with coronary artery disease. Cochrane Database Syst Rev 2021; (12) CD008012 DOI: 10.1002/14651858.CD008012.pub4. (PMID: 34910821)
• 53 Cipriani A, Furukawa TA, Salanti G. et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Lancet 2018; 391: 1357-1366 DOI: 10.1016/S0140-6736(17)32802-7. (PMID: 29477251)
• 54 Ladwig KH, Lurz J, Lukaschek K. Herzerkrankungen im Langzeitverlauf: Wie kann die psychosoziale Versorgung verbessert werden?. Bundesgesundheitsbl 2022; 65: 481-487
• 55 Levine GN, Cohen BE, Commodore-Mensah Y. et al. Psychological Health, Well-Being, and the Mind-Heart-Body Connection A Scientific Statement From the American Heart Association. Circulation 2021; 143: E763-E783 DOI: 10.1161/CIR.0000000000000947. (PMID: 33486973)
• 56 Herrmann-Lingen C, Albus C, de Zwaan M. et al. Efficacy of team-based collaborative care for distressed patients in secondary prevention of chronic coronary heart disease (TEACH): study protocol of a multicenter randomized controlled trial. BMC Cardiovascular Disorders 2020; 20: 1-14 DOI: 10.1186/s12872-020-01810-9. (PMID: 33302871)
• 57 Lurz J, Ladwig KH. Mind and body interventions in cardiology: The importance of the brain–heart connection. Herz 2022; 47: 103-109 DOI: 10.1007/s00059-022-05104-y. (PMID: 35292838)
• 58 Hare DL. Successful psychological treatment of depression an subsequent reduction in CVD events. Eur Heart J 2023; 44: 1663-1665
• 59 Ladwig K-H, Baghai TC, Doyle F. et al. Mental health-related risk factors and interventions in patients with heart failure: a position paper endorsed by the European Association of Preventive Cardiology (EAPC). Eur J Prev Cardiol 2022; 29: 1124-1141 DOI: 10.1093/eurjpc/zwac006.