Abstract 1336: Selective Serotonin Reuptake Inhibition Reduces Circulating Markers of Oxidative Stress in Depressed Patients With Chronic Heart Failure
The role of oxidative stress has never been investigated in chronic heart failure (CHF) patients with depression.
Methods: Two-hundred CHF patients (LVEF <40%) were asked to complete depression screening instruments Beck Depression Inventory (BDI) and Zung Self-rating Depression Scale (Zung SDS). Those with BDI >10 and Zung SDS>40 underwent a phsychiatric interview. Patients newly diagnosed as depressed, received treatment with a selective serotonin reuptake inhibitor (sertraline 50 mg od) for three months (arm A) and were compared with those who did not comply with the treatment three months later (arm B). Thirty non-depressed patients matched for age, sex and CHF severity, were used as controls (arm C). Oxidative markers such as malondialdeyde (MDA), nitrotyrosine (NT) and protein carbonyls (PCs) were assessed baseline and 3 months later.
Results: Forty-one patients were depressed (20%). These patients had significantly higher levels of MDA than non-depressed [3.2 (range 1.53–12.8) ng/ml vs 2.1 (range 1.4 –23.0) ng/ml, p<0.01]. PCs and NT levels were also higher (not significantly) in the depressed group (1.9 (range 1.1– 8.6) ng/ml vs 1.5 (range 0.15–3.99) ng/ml for PCs and 6.3 (range 0.1–1231.0) nmol/lt vs 2.1 (range 0.2– 84.0) nmol/lt. Twenty-nine depressed patients completed the follow-up period. Fifteen patients were under sertraline (arm A), while 14 refused to follow antidepressant treatment (arm B). While baseline levels of MDA in arm A and arm B did not differ significantly, only arm A experienced a significant reduction on MDA levels [2.5 (range 1.45–5.4) vs 2.2 (range 0.4 –3.6)], while arm B experienced an increase on MDA levels [2.3 (range 1.0 – 4.02) vs 3.0 (range 0.4 –12.8)], p=0.03, F=5.2. A trend for change of PCs levels was also observed [1.9 (range 1.1–3.1) ng/ml vs 1.6 (range 0.97–2.5) mg/ml in arm A, 1.4 (0.2–2.3) ng/nl vs 1.7 (range 1.1– 8.6), p=0.07, F=3.5. Concerning the scores, arm A had a decrease in BDI [26 (range 13– 48) versus 17 (range 5– 44)] while arm B had an increase in BDI [23 (range 10 –39) versus 25 (range 8 – 40)], F=4.56, p=0.046.
Conclusion: Increased oxidative stress may actively be implicated in the pathophysiology of depressive symptoms in CHF. Sertraline improves depressive symptomatology and reduces oxidative stress in CHF.