VII.18. Depression

In the event of mental diseases, the development of CVDs is 2-3 times more frequent.

It is expected that by 2020 unipolar depression and its clinical consequences will be in second place after CVDs. The incidence of schizophrenia and bipolar depression is increasing.   

Depression is sign of physiological stress on the body. The increased blood Glu level in diabetes is a risk factor for depression. On the other hand, T2DM develops in 40% of patients with depression. The increased fat mass and waist-hip ratio caused by obesity correlate well with the development of depression. There are 2 times as many smokers in the depressed population than among the general population. The quit-smoking cessation programs are less effective among the depressed. More depressed people consume alcohol and they do less physical activity.  

In depression, the CRH and cortisol levels are higher. The higher cortisol levels induce insulin resistance. Estrogen defends against stress and depression in women, but after menopause its level decreases. The TNF-α and C reactive protein levels are increased by depression. The platelet activation and aggregation are enhanced, and therefore the cardiovascular risk increases (Table 9).

 Table 9. Schizophrenia and bipolar depression as cardiovascular risk factors

Antidepressants are serious risk factors. For example, Li⁺ and valproate increase the body weight. They increase the levels of LDL and TG, decrease that of HDL, and enhance the risk of the development of DM. Fortunately, the new generation of medicaments has decreased these risk factors significantly, but they still exist.