Cardiovascular Implications of Stress and Depression

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CARDIOVASCULAR
IMPLICATIONS
OF STRESS AND
DEPRESSION
Copyright
Contributors
1
Stress, depression, and cardiovascular disease
	Basic definitions
	Conceptual models linking stress with depression and cardiovascular disease
	Mechanisms linking stress with cardiovascular disease
	Conclusion
	References
Section 1: Evidence linking stress with depression and cardiovascular disease
2  Evidence linking stress with depression and cardiovascular disease
	Epidemiological evidence linking stress and depression with CVD
		Methodological considerations
		Stress and cardiovascular disease
		Depression and cardiovascular disease
		Conclusion
		References
3
Translational research from animal models
	Introduction: The translational value of research with animal models
	Animal models and operational definitions of depression
		Exposure to unpredictable environmental stressors: Chronic mild stress
		Exposure to social stressors: Social defeat, disrupted social bonds and isolation, and social subordination
		Exposure to physical stressors: Coronary artery ligation and olfactory bulbectomy
	Mechanisms, pathways, and physiological correlates
		Autonomic imbalance
		Cardiac instability and arrhythmias
		Vascular hyper-reactivity and atherosclerosis
		Endocrine and immune dysfunction
		CNS dysregulation
	Concluding remarks
	References
4
Intervention research on therapies that aim to treat depression and cardiovascular disease
	Psychosocial and behavioral interventions
	Cognitive-behavioral therapy
	Collaborative care
	Cardiac rehabilitation and exercise
	Stress management/relaxation training
	Caregiver interventions
	Nutritional interventions
	Pharmacotherapy
	Other pharmacotherapy treatment
	Combined behavioral and psychopharmacology interventions
	Limitations
	Summary of findings and future considerations
	References
Section 2: Mechanisms linking stress and depression with cardiovascular disease
5
Autonomic and neuroendocrine response to stress
	The autonomic nervous system
	The neuroendocrine system
	Pathological patterns of autonomic nervous and neuroendocrine system functioning
	Exposure to stress and allostatic load
		Stress and exaggerated physiological response
		Stress and blunted physiological response
		Stress and delayed recovery
	Allostatic load and risk for cardiovascular disease
		Exaggerated physiological response to stress and risk for CVD
		Blunted physiological response to stress and risk for CVD
		Prolonged recovery from stress and risk for CVD
	Depression and allostatic load
		Depression and exaggerated physiological response to stress
		Depression and blunted physiological response to stress
		Depression and prolonged recovery from stress
	Summary and conclusions
	References
6
Circulatory system alterations under stress
	Vascular dysfunction
		Endothelial function
		Arterial remodeling
			Arterial stiffness
			Atherosclerosis
			Vessel density
		Sex specific differences in arterial function
		The role of pre-existing CVD on arterial function
	Potential mechanisms leading to vascular dysfunction and remodeling
		Oxidative stress
		Inflammation
		Stress hormones and autonomic nervous system function
	Adverse effect of stress on the heart
	Summary and conclusions
	References
7
Human neuroimaging-based connections between stress, cardiovascular disease and depression
	Introduction
	Neuroimaging methods
	Cortical responses to stress and the brain regions affected
		Acute stress exposure and the brain
		Chronic stress exposure and the brain
		Exposure to extreme stress and the brain
		Exposure to early life stress and the brain
	Cortical responses to stress and CVD
	Cortical responses to stress and depression
	Therapies and treatments: Effect on brain
		Physical exercise
		Dietary interventions
		Stress management
		Behavior therapy
	Summary
		Neuroimaging use in informing CVD/depression treatment and risk abatement
		Conclusion
	References
	Further reading
8
The role of inflammation and oxidative stress in depression and cardiovascular disease
	Introduction
	Stress as a catalyst for inflammation
		Stress-induced breakdown of the BBB as a source of neuroinflammation
		Stress-induced activation and sensitization of microglia as a source of neuroinflammation
		Stress-related dysfunction in the adaptive immune system
	Stress as a catalyst for reactive oxygen species (ROS) accumulation: A role for mitochondrial dysfunction
	Inflammation in the pathophysiology of depression
		Inflammation in the pathogenesis of depression: Correlation or causation?
		Microglial polarization in depression
		Adaptive immune system imbalance in depression
		BBB permeability in depression
	ROS in the pathogenesis of depression
	Inflammation in the pathogenesis of CVD
		Innate and adaptive immunity in CVD
		Putative neurogenic regulation of CVD
	ROS in the pathogenesis of cardiovascular disease
	Inflammation and ROS responses to stress as a mechanism through which stress leads to depression and cardiovascular disease ...
	Conclusion
	References
9
Social support and stress, depression, and cardiovascular disease
	The link between stress and social support
	The link between depression and social support
	The link between social support, biological risk, and cardiovascular disease
	Social support as a mediator
	Intervention implications
	Conclusions
	References
10
The influence of health behaviors upon the association between stress and depression and cardiovascular disease ☆
	Tobacco use
		Relations with stress
		Relations with CVD
		Relations with depression
	Alcohol use
		Relations with stress
		Relations with CVD
		Relations with depression
	Physical inactivity
		Relations with stress
		Relations with CVD
		Relations with depression
	Dietary habits
		Relations with stress
		Relations with CVD
		Relations with depression
	Overweight and obesity
		Relations with stress
		Relations with CVD
		Relations with depression
	Medication and medical regimen adherence
		Relations with stress
		Relations with CVD
		Relations with depression
	Sleep
		Relations with stress
		Relations with CVD
		Relations with depression
	Summary
	References
	Further reading
11
The microbiome-gut-brain axis: The missing link in depression
	Introduction
		The gut microbiome: A critical component of the human superorganism
		The vocabulary of microbial genomics
		Microbiome research: Then and now
	The bidirectional microbiome-gut-brain axis
		Communication pathways from the brain to the gut microbiome
		Communication pathways from the gut microbiome to the brain
	Relationships between stress and the gut microbiome
		Effects of stress on the gut microbiome
		Effects of the gut microbiome on physiological and behavioral responses to stress
	Relationships between depression and the gut microbiome
		Evidence for a role of the gut microbiome in risk of MDD
		Evidence for effects of MDD on the gut microbiome
	Early-life stress and depression
	Relationships between cardiovascular disease and the microbiome
		Evidence for a role of the gut microbiome in risk of CVD
		Evidence for effects of CVD on the gut microbiome
		Evidence that gut microbiome responses to stress could be a mechanism through which stress leads to MDD and CVD
	Conclusions and future directions
	Disclosures
	References
12
Future directions and concluding remarks
	Causal relations among stress, depression, and cardiovascular disease
		Epidemiologic research
		Translational animal research
		Clinical intervention trials
		Summary of evidence regarding causality
	Mechanisms linking stress with depression and cardiovascular disease
		External stimuli
		Cortical response to stress
		Autonomic nervous system response to stress
		Neuroendocrine response to stress
		Immune system response to stress
		Cardiac and vascular response to stress
		Microbiota and gut response to stress
		Health behaviors in response to stress
		Summary
	Future research directions
		Chronic versus acute stress
		Individual difference moderators
		Multi-method multi-system research
		Measurement of stress and depression
		Genetic influences
	Conclusion
	References
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