Physical Consequences of Depression [Hardcover]

Jogin Thakore (Editor)

Book Description

ISBN-10: 1871816440 | ISBN-13: 978-1871816440 | Publication Date: August 24, 2001 | Edition: 1

introduce the molecular biology of the HPA axis in normal and depressed patients, look at corticosteroid receptors in the brain, and go on to describe the complex interrelationship between the HPA axis and the immune system. Chapter 4 explores the epidemiological link between depression and physical disease and Chapters 5-8 discuss depression and specific physical diseases: diabetes, osteoporosis, cardiovascular disease and disorders of the immune system. Finally, Chapters 9 and 10 look at future treatment strategies.

Editorial Reviews

From The New England Journal of Medicine

At a time when seemingly irreconcilable global conflicts, daily threats of terrorism, and continuous reports of violence against children have pushed environmental stress past the boiling point, it should be no surprise that rates of depression and other stress-related illnesses have soared. This is hardly a trivial problem, since depression itself may have serious consequences. Physical Consequences of Depression is a well-documented exploration of the links between depression and a variety of physical illnesses. Although the evidence of associations between depression and cardiovascular disease and diabetes is the strongest, data are also presented suggesting links with osteoporosis, human immunodeficiency virus infection and the acquired immunodeficiency syndrome, stroke, and the prognosis in cancer. Of particular interest is the claim that even minor degrees of depression carry substantial risk, especially with respect to cardiovascular disease. The authors describe a mechanism by which depression could have such substantial physical effects: dysregulation of the hypothalamic-pituitary-adrenal axis with chronic elevation of cortisol levels. In the brain, such dysregulation would have many effects, including impairment of serotonergic transmission. In the cardiovascular system, chronic elevation of the cortisol level is associated with increased activity of the autonomic nervous system, hypertension, disturbed carbohydrate and lipid metabolism, and eventually, an increased risk of myocardial infarction. Sections devoted to the metabolic syndrome and the concept of allostatic load will help readers who are unfamiliar with these important topics. The central role of increased visceral (intraabdominal) fat deposition is clearly established, and considering the ease with which these deposits can be estimated by a simple waist-to-hip ratio, one wonders why this measurement is not part of routine clinical practice. Furthermore, all of the markers of allostatic load -- elevated cortisol levels, elevated catecholamine levels, hypertension, poor blood sugar control, increased visceral fat deposition, and reduced dehydroepiandrosterone sulfate levels -- are accessible for clinical use. The book cites evidence that these markers predict the development of cardiovascular disease and cognitive decline. Interestingly, even relatively higher levels of cortisol and catecholamines, not just clinically abnormal levels, are said to be predictive. What does all this have to do with stress in the world? Simply this: if we are unable to contain stressors in the environment, then we had better figure out ways to control the individual person's response to stress. If we do not, the eventual public health consequences could be catastrophic. The authors of this book make clear that effective treatment of depression initiates a desirable cascade of events: normalization of the hypothalamic-pituitary-adrenal axis, reduction in visceral adiposity, and correction of related autonomic nervous system and neuroendocrine abnormalities. This cascade, of course, is associated with a reduced risk of diabetes and myocardial infarction, among other diseases. Although treatments for depression are directed mainly at neurotransmitters, they are also effective in restoring regulation of the hypothalamic-pituitary-adrenal axis. Alternative interventions are possible, however, and the book offers a detailed look at several. For example, cortisol levels can be lowered directly by blocking enzymes involved in the synthesis of cortisol by the adrenal glands. Ketoconazole, metyrapone, and aminoglutethimide have this effect, and all have been shown to have antidepressant effects but are not in clinical use for this indication because of severe side effects. Alternatively, brain cortisol-receptor antagonists such as mifepristone (RU 486), corticotropin-releasing hormone receptor antagonists, or supplemental dehydroepiandrosterone have shown promise. Furthermore, and perhaps of more immediate clinical interest, effective stress-reduction programs involving relaxation and meditation have been shown to decrease cortisol levels and increase dehydroepiandrosterone levels. Considering the public health issues at stake, this book could probably lay claim to a wider audience than the editor modestly recognizes in the preface. It should be of interest not only to psychiatrists, internists, general practitioners, and basic scientists working in related areas, but also to cardiologists, diabetologists, and specialists in obesity. As with any edited work, the chapters vary in terms of the amount of specialized knowledge required, and the book could be faulted for the lack of a summary chapter that ties together the links between depression and physical disease. This lack is particularly apparent when it comes to links to the immune system; some very interesting data are presented concerning the action of inflammatory cytokines on the hypothalamic-pituitary-adrenal axis, but the implications do not become part of the overall theme of the book and so are reduced to an undeserved incidental status. In addition, there is minimal treatment of the effects of depression on the brain itself, a topic that some of the contributors could easily address. These criticisms are small, however; overall, the book's content is important, and the work provides a platform for further investigation and discussion. Sandra Jacobson, M.D.
Copyright © 2003 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS.

About the Author

Jogin Thakore is a Senior Lecturer in Psychiatry and Consultant Psychiatrist at St. Vincent's Hospital, Dublin, Ireland.

Product Details

• Hardcover: 256 pages
• Publisher: Routledge; 1 edition (August 24, 2001)
• Language: English
• ISBN-10: 1871816440
• ISBN-13: 978-1871816440
• Product Dimensions: 8.9 x 7 x 0.8 inches
• Shipping Weight: 1.4 pounds
• Amazon Best Sellers Rank: #7,248,401 in Books (See Top 100 in Books)