Mood disturbances in vascular diseases
Journal Title: Postępy Nauk Medycznych - Year 2010, Vol 23, Issue 4
Abstract
Comorbidity of depression and vascular disorders is significant clinical problem. Depression very often is tied up to coronary heart disease, and its vascular consequences, and also is an independent risk factor of stroke. Peripherial vascular risk factors increase damage of vascular system in the brain, thus increasing prevalence of depression. Hypothesis of vascular depression is trying to combine all important risk factors,as heart diseases,vascular disease,diabetes, hyperlipidemia with its consequences in brain. Damage of small brain vessels disturb neurotransmitter systems,especially in fronto-subcortical circuit initiating inflammatory cascade ,which shows on clinical level as subcortical depression. Atherogenic damage of bigger vessels is responsible for stroke. In different hypotheses regarding post-stroke depression polymorphism in transporter serotonin gene, serotoninergic dysfunction and localization,i.e. left frontal lobe seems to be important. Vascular and post-stroke depressions are characterized by chronic course, treatment resistance and higher rate of mortality. Post-stroke depression is diagnosed rare, and patients do not accept therapeutic and rehabilitation procedures.In therapy several approaches simultaneously should be implemented: treatment of comorbid physical diseases,antidepressants and psychotherapy. Safe and effective drugs in vascular and post-stroke depressions include serotoninergic and dopaminergic reuptake inhibitors and drugs increasing transmission in two systems: serotoninergic and noradrenergic.
Authors and Affiliations
Tadeusz Parnowski
Keywords
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