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Depression and Whole Blood Serotonin in Patients With Coronary Heart Disease From the Heart and Soul Study

From the Department of Psychiatry (L.W.), University of Cincinnati, Cincinnati, Ohio; Department of Psychiatry and Behavioral Sciences (D.M., E.B.), Emory University, Atlanta, Georgia; Department of Psychiatry (C.O.), University Hospital Hamburg-Eppendorf, Hamburg, Germany; VA Medical Center (S.A., M.A.W.), San Francisco, California; and the Departments of Medicine and Epidemiology and Biostatistics (M.A.W.), University of California, San Francisco, San Francisco, California.

Address correspondence and reprint requests to Lawson Wulsin, PO Box 670559, Cincinnati, OH, 45267-0559. E-mail: Lawson.wulsin{at}uc.edu

Objective: To evaluate whether depression is associated with whole blood serotonin in outpatients with stable coronary heart disease (CHD). Depression is associated with incident CHD and with adverse cardiovascular outcomes. Dysregulation of peripheral serotonin, common to both depression and CHD, may contribute to this association.

Methods: We performed a cross-sectional study of 791 participants with stable CHD enrolled in the Heart and Soul Study and not taking antidepressant medication. We assessed major depression using the Computerized Diagnostic Interview Schedule (CDIS-IV) and measured whole blood serotonin (WBS) from fasting venous samples.

Results: Of the 791 participants, 114 (14%) had current (past month) major depression, 186 (24%) had past (but not current) major depression, and 491 (62%) had no history of depression. Age-adjusted mean WBS was higher in participants with current major depression (139 ± 6.5 ng/ml) than in those with past depression (120 ± 5.0 ng/ml) or no history of depression (119 ± 3.1 ng/ml) (p = .02). This association was unchanged after adjustment for demographic characteristics, medical comorbidities, medication use, and cardiac disease severity (p = .02). When serotonin was analyzed as a dichotomous variable, current depression was associated with a 70% greater odds of having WBS in the highest quartile (adjusted odds ratio = 1.71; 95% Confidence Interval = 1.03–2.83; p = .04).

Conclusions: In this sample of patients with stable CHD, current major depression was independently associated with higher mean WBS levels. Future studies should examine whether elevated WBS may contribute to adverse outcomes in patients with depression and CHD.

Key Words: depression • coronary heart disease • whole blood serotonin

Abbreviations: CHD = coronary heart disease; CDIS = computerized diagnostic interview schedule; HPLC = high pressure liquid chromatography; LVEF = left ventricular ejection fraction; MI = myocardial infarction; WBS = whole blood serotonin; 5-HT1 = 5-hydroxytryptophan 1; 5-HT2 = 5-hydroxytryptophan 2.