The burden of mood-disorder/cerebrovascular disease comorbidity: essential neurobiology, psychopharmacology, and physical activity interventions

Abstract

Cardio-vascular diseases (CVDs) and CVD-related disorders (including cerebrovascular diseases; CBVDs) are a major public health concern as they represent the leading cause of mortality and morbidity in developed countries. Patients with CVDs and CBVDs co-morbid with mood disorders, especially bipolar disorder (BD) and major depressive disorder (MDD), suffer reduced quality-of-life and significant disability adjusted for years of life and mortality. The relationship between CVDs/CBVDs and mood disorders is likely to be bidirectional. Evidence for shared genetic risk of pathways involved in stress reaction, serotonin or dopamine signalling, circadian rhythms, and energy balance was reported in genome-wide association studies. There is some evidence of a neuroprotective effect of various antidepressants, which may be boosted by physical exercise, especially by aerobic ones. Patients with CVDs/CBVDs should be routinely attentively evaluated for the presence of mood disorders, with tools aimed at detecting both symptoms of depression and of hypomania/mania. Behavioural lifestyle interventions targeting nutrition and exercise, coping strategies, and attitudes towards health should be routinely provided to patients with mood disorders, to prevent the risk of CVDs/CBVDs. A narrative review of the evidence is herein provided, focusing on pharmacological and physical therapy interventions.

Keywords:

• Depression
• bipolar disorder
• cardiovascular disease
• cognition
• stroke
• comorbidity
• quality-of-life
• psychopharmacology
• physical activity
• exercise

Acknowledgements

MGC conceived the study and served as senior study reviewer and coordinator. MF and MS jointly drafted the main-text focusing of psychopharmacological interventions. AP, NV, as well as additional co-authors either assisted in proof-reading and/or references’ collection or specific portions of the text, focusing of physical activity interventions.

Disclosure statement

While none of the authors enlisted in the present study received any grant or founding whatsoever in conjunction with the present manuscript, neither any financial support by any of the manufactures of the drugs mentioned in the text, senior and corresponding author Professor Mauro Giovanni Carta received grants from the European Commission, European Social Fund, AIFA (Agenzia Italiana del Farmaco), Fondazione Banco di Sardegna nd the Sardinia Region, Italy. Professor Carta also serves as an advisor for the Economic and Social Committee of the European Union.