心臟疾病與憂鬱疾患

Heart Disease and Depression

併有身體疾病的病人通常帶有憂鬱疾患。目前日本國立神經內科及精神醫學研究中心， 與其他五大中心，聯合開始共同研究，以便改善併有身體疾病的病人的精神科照顧之品質。 在本綜說中，作者回顧併有心臟疾病的帶有憂鬱疾患病人的發生率、憂鬱疾患對心臟疾病病 人的預後影響程度、憂鬱疾患對心臟疾科病人的可能的作用機轉、心臟科藥物與精神料藥物 的交互作用、及針對這些病人的可能治療方法。憂鬱疾患與心臟疾病常常共存，而且由其中 的一種疾病會引起另外的一種疾病。用生物學上及行為學上的作用機轉，來解釋兩種疾病關 連性的理論，包括自律神經的活動力變化、血小板的功能障礙、心血管內膜功能失常、體內 發炎的變化、及與健康有關的行為等。三環抗憂鬱劑與心臟科藥物同時服用，需注意兩種藥 物的交互作用。通常帶有心臟病人病人，建議使用選擇性血清素回收抑制劑 (SSRIs) 當做第 一線抗憂鬱劑，來治療中度性或嚴重性的憂鬱症疾患。雖然目前沒有任何單一治療方式，可 以當作這些病人的標準治療方法，但是目前研究發現會成功的治療方法，要同時考量到憂鬱 症狀及心臟病的治療情況，及兼顧到病人的看法。總之，治療這些併有心臟疾病病人的憂鬱 疾患，需要聚集心臟學及精神醫學兩方面的專業知識，而精神科醫師在病人治療中，扮演了 很重要的角色。

Depression is common in patients with physical illness. The National Center of Neurology and Psychiatry has launched a joint project with five other centers in Japan, aiming at improving the quality of mental care in patients with physical ill- ness. In the present overview focusing on heart disease, we review the prevalence of depression in patients with heart disease, the impact of depression on cardiac prognosis, the possible mechanisms of depression in patients with heart disease, drug-drug interactions between cardiac and psychotropic agents and the possible therapeutic approaches to treating these patients. Depression and heart disease of- ten coexist and each can lead to the other. Various biological and behavioral mech- anisms have been proposed to explain an association between heart disease and depression, including autonomic nervous system activity, impairment of platelet function, endothelial dysfunction, inflammatory changes, and health-related be- haviors. Combination therapy with tricyclic antidepressant and cardiac agents must be approached with caution to avoid drug-drug interactions. Selective sero- tonin reuptake inhibitors (SSRIs) are the first line treatment for patients with heart disease and moderate to severe depression. Although no single intervention has been established as the standardized treatment, recent studies suggest that collab- orative care improves both depressive symptoms and cardiac outcomes, and that patient’s participation is a key to successful treatment. Bridging the gap between cardiology and psychiatry is essential, and psychiatrists can play a vital role in tak- ing care of the mental health of patients with heart disease.