History of Major Depressive Disorder and Endothelial Function in Postmenopausal Women

Objective: To determine whether history of depression is associated with endothelium-dependent flow-mediated dilation (FMD) in postmenopausal women. Methods: Thirty-nine postmenopausal women with no known or suspected cardiovascular disease participated. Nineteen had a positive lifetime history of major depressive disorder, and 20 were never depressed. None were currently depressed, and all had been free of major depressive disorder and antidepressant medications for ≥1 year. History of depression was assessed with the Structured Clinical Interview for DSM-IV, enhanced by a modified version of the timeline follow-back method. Current depressive symptoms were measured with the Center for Epidemiological Studies Depression scale (CES-D). Brachial artery FMD was measured with ultrasound and calculated as percent dilation from baseline. Results: After controlling for current subclinical depressive symptoms, ethnicity, hormone replacement therapy, and presence of the metabolic syndrome, previously depressed women showed significantly and clinically meaningful lower FMD than never depressed women. Controlling the same covariates, there was a dose-response relationship between number of depressive episodes and FMD. Examination of FMD means showed a significant negative correlation between number of depressive episodes and FMD. Conclusion: In postmenopausal women, depression continues to show a negative relationship to endothelial functioning even after years of remission. This relationship is not accounted for by residual depressive symptoms. Implications pertain to exclusion of previously depressed persons from control groups in research exploring the relationship between depression and cardiovascular disease. CHD = coronary heart disease; FMD = flow-mediated dilation; CES-D = Center for Epidemiological Studies Depression questionnaire; BMI = body mass index; SCID = Structured Clinical Interview for DSM-IV; TLFB = timeline follow-back; HRT = hormone replacement therapy.

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