Atypical Depression in Patients With Chronic Ischemic Heart Disease

Research objective. To study the frequency of detecting atypical depression, clinical features and differences in blood biochemical parameters in patients with chronic ischemic heart disease, depending on the presence of an atypical specification of depression.Materials and methods. In the Department of Rehabilitation of Patients with Cardiovascular Diseases of the Cardiology Research Institute of the Tomsk NRMC, patients (n=262) with affective disorders in chronic IHD were identified and examined. Among them, 77.5% (203/262) were men and 22.5% (59/262) were women, the average age amounted to 57.7 (6.7) years.Along with the clinical one, a psychometric method (Structured Interview Guide for the Hamilton Depression Rating Scale, Seasonal Affective Disorders Version –SIGH-SAD) and a biochemical blood test were used.Qualitative and quantitative indicators were investigated using the Mann-Whitney tests and the T-test; for assessing frequencies, the Pearson’s chi-squared test, correlation analysis (Spearman’s nonparametric test and Pearson’s parametric test) were used to study the relationship of signs (at p≤0.05).Results. 41.4% had a family history of mental disorders (alcohol dependence, mood disorders, suicides and accidents).Symptomatically, in patients with affective disorders and chronic IHD, somatic complaints were primary (pressing chest pains, palpitation, intermissions, weakness, dyspnea), along with somatic symptoms of depression (dyssomnia, appetite disorder, changes in body weight, fatigue, decreased activity and working capacity, troubles in sexual sphere, chronic pain syndrome of various localization). The conversation also revealed psychological symptoms of depression.Syndromologically, in 92% (241/262), depression had a second significant component (most often anxious) – 57.3% (150/262). Along with anxiety symptoms, attention was drawn to the atypical specification of depression (42.4%, 111/262), in accordance with the DSM-V criteria. Among them, 26.1% (n=29) were women and 73.9% (n=82) were men.Nosologically, in patients with atypical specification, dysthymia prevailed – 43.2% (48/111); DE was revealed in 22.5% (25/111), RDD in 27% (30/111), BPAD in 7.2% (8/111). In addition, polymorbidity with alcohol (22.1%) and nicotine (28.6%) addiction was revealed.In 33.9% (89/262) of patients, depression was melancholic, of which 75.3% (67/89) were men and 24.7% (22/89) were women. In 23.7% (62/262) of patients, the type of depression could not be established. Atypical and non-atypical depression were statistically significantly different in the mean score of the atypical SIGH-SAD subscale (8 (6-10) versus 4 (3-6), p<0.05, Mann-Whitney test).The presence of more severe AD (BPAD, RDD) correlated with PICS (rs=0.2).Cardiac care requests for patients with the atypical depression specification were seasonal (December to April).A comparative analysis of the values of triglycerids (TG), low-density lipoproteids (LDL), high-density lipoproteids (HDL), atherogenic index (AI), total protein, uric acid, body mass index (BMI), cortisol revealed statistically significant differences depending on the type of an affective disorder (p=0.00, Mann-Whitney test), which indicates more pronounced violations of biochemical parameters and the presence of metabolic syndrome components in atypical depression.Conclusion. Atypical depression can be a link in the clinical manifestations and pathogenesis of affective disorders and ischemic heart disease