Hart en/of ziel? Werkelijkheid en fictie in de relatie tussen volksziekten nummer 1 en 2 - hart- en vaatziekten en depressie

Depression and heart disease are the strongest contributors to the global burden of disease and are often intertwined: depression is a risk factor for heart disease and vice versa. Moreover, depression in patients with established heart disease is associated with cardiovascular disease progression. Still, several large-scale attempts to treat depression in order to improve cardiovascular prognosis have not been successful. in my view this is due to an overinclusive psychiatric diagnostic system on the one hand, and an overemphasis on antidepressant drugs with limited antidepressive effectiveness. The overinclusive psychiatric diagnostic system is reflected by the inclusion of depression cases, mostly induced by external stressors, with a high proportion of spontaneous recovery. The limited antidepressive properties of antidepressants is illustrated by 1-4% of explained variance of depressive symptoms attributable to the prescription of drugs, compared to placebo. Two promising alternative strategies to prevent the deleterious effects of depression on heart disease prognosis are presented, i.e. by promoting physical exercise and by preventing withdrawal from cardiac (after)care. Recent research has demonstrated that reduced physical exercise and inadequate cardiac care can explain away a significant proportion of the effects of depression on cardiovascular prognosis. in future intervention trials, strategies to prevent these effects should be evaluated. Furthermore, a plea is made to reduce financial interests in psychiatric research, to promote creativity and to emphasize training of young researchers