期刊
PSYCHONEUROENDOCRINOLOGY
卷 38, 期 2, 页码 209-218出版社
PERGAMON-ELSEVIER SCIENCE LTD
DOI: 10.1016/j.psyneuen.2012.05.017
关键词
Anxiety; Depression; Tricyclic antidepressants; HPA axis; Autonomic nervous system; Inflammation; Lifestyle
资金
- Geestkracht program of the Netherlands Organization for Health Research and Development (ZonMw) [10-000-1002]
- VU University Medical Center
- GGZ inGeest
- Arkin
- Leiden University Medical Center
- GGZ Rivierduinen
- University Medical Center Groningen
- Lentis
- GGZ Friesland
- GGZ Drenthe
- Scientific Institute for Quality of Health Care (IQ Healthcare)
- Netherlands Institute for Health Services Research (NIVEL)
- Netherlands Institute of Mental Health and Addiction (Trimbos)
Background: Dyslipidemia and obesity have been observed in persons with severe anxiety or depression, and in tricyclic antidepressant (TCA) users. This likely contributes to the higher risk of cardiovascular disease (CVD) in anxiety and depressive disorders. We aimed to elucidate whether biological stress systems or lifestyle factors underlie these associations. If so, they may be useful targets for CVD prevention and intervention. Methods: Within 2850 Netherlands Study of Depression and Anxiety (NESDA) participants, we evaluated the explaining impact of biological stress systems (i.e., the hypothalamic-pituitary- adrenal [HPA] axis, autonomic nervous system [ANS] and inflammation) and lifestyle factors (i.e., tobacco and alcohol use, and physical activity) on adverse associations of anxiety and depression severity and TCA use with high and low-density lipoprotein cholesterol, triglycerides, body mass index and waist circumference. Through linear regression analyses, percentual change (%Delta) in beta was determined and considered significant when %Delta > 10. Results: The inflammatory marker C-reactive protein had the most consistent impact (explaining 14-53% of the associations of anxiety and depression severity and TCA use with lipid and obesity levels), followed by tobacco use (explaining 34-43% of the associations with lipids). The ANS mediated all associations with TCA use (explaining 32-61%). The HPA axis measures did not explain any of the associations. Conclusions: Increased dyslipidemia and (abdominal) obesity risk in patients with more severe anxiety disorders and depression may be partly explained by chronic low-grade inflammation and smoking. TCAs may increase metabolic risk through enhanced sympathetic and decreased parasympathetic ANS activity. That the HPA axis had no impact in our sample may reflect the possibility that the HPA axis only plays a role in acute stress situations rather than under basal conditions. (C) 2012 Elsevier Ltd. All rights reserved.
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