It is well known that depressive disorder is associated with an increased risk of cardiovascular diseases; however, the pathophysiological mechanisms illuminating the relationship between depression and cardiovascular risk still remain unclear. Notably, adolescence represents a critical and vulnerable age period for potential depression-induced cardiovascular complications due to developmental and brain maturational changes; thus, adolescent major depression could represent an important risk factor for cardiovascular adverse outcomes that manifest in adulthood. This aspect seems crucial in terms of prevention. Therefore, the aim of this review is to characterize the main regulatory mechanisms involved in the onset and progression of cardiovascular illnesses associated with depressive disorder at adolescent age, from a pathophysiological and clinical point of view. This review is focused on the description of the unique role of allostasis-linked systems such as autonomic nervous system in depressive disorder and inflammatory regulation/dysregulation whose interaction is mediated through the extensively discussed “cholinergic anti-inflammatory pathway”. Further insight into the mechanisms underlying both vagal regulation and the cholinergic anti-inflammatory pathway may lead to effective new treatments for major depression, especially at the adolescent age.
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