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Regarding “Depression and Inflammation in Patients with Coronary Heart Disease: Findings from the Heart and Soul Study”

      In a large, cross-sectional study of patients with stable coronary artery disease (CAD) Whooley et al. (
      • Whooley M.A.
      • Caska C.M.
      • Hendrickson B.E.
      • Rourke M.A.
      • Ho J.
      • Ali S.
      Depression and inflammation in patients with coronary heart disease: findings from the heart and soul study.
      ) found no association between plasma inflammatory mediators and depression. This is consistent with findings in depression after myocardial infarction (
      • Schins A.
      • Tulner D.
      • Lousberg R.
      • Kenis G.
      • Delanghe J.
      • Crijns H.J.
      • et al.
      Inflammatory markers in depressed post-myocardial infarction patients.
      ). One possible explanation, mentioned by the authors, is that there may be a ceiling effect as both depression and CAD is associated with inflammation. In addition to statins, beta-blockers and antidepressants also reduce inflammation (
      • Kenis G.
      • Maes M.
      Effects of antidepressants on the production of cytokines.
      ,
      • Lanza G.A.
      • Pitocco D.
      • Navarese E.P.
      • Sestito A.
      • Sgueglia G.A.
      • Manto A.
      • et al.
      Association between cardiac autonomic dysfunction and inflammation in type 1 diabetic patients: effect of beta-blockade.
      ). In Whooley’s cohort ∼60% were taking statins, ∼60% beta-blockers, and half of the depressed patients were taking antidepressants. These medications may have reduced inflammation and thus masked any association between depression and inflammatory mediators. Of the depressed patients in this cohort, 47% had not responded to their current antidepressant therapy. It was recently shown that inflammatory mediator levels were higher among patients who had failed to respond to an adequate SSRI trial compared both to healthy controls and to euthymic patients with a history of failing SSRI treatment (
      • O’Brien S.M.
      • Scully P.
      • Fitzgerald P.
      • Scott L.V.
      • Dinan T.G.
      Plasma cytokine profiles in depressed patients who fail to respond to selective serotonin reuptake inhibitor therapy.
      ). Therefore, in future cross-sectional studies of associations between depression and inflammation in the context of CAD, it may be useful to separate subgroups of depression according to treatment response and current antidepressant use.
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