Hopelessness and the Heart Attack: The Role of Depression in Heart Disease
“Everybody obviously has a mood dip after a heart attack,” says Laura Kubzansky, PhD, MPH, an assistant professor of society, human development, and health at Harvard University. But in recent studies, she says, heart attack victims diagnosed with medical depression fared significantly worse than heart attack victims without signs of depression. Interestingly, these studies suggest that many of these depressed patients were never depressed or treated for depression before they had heart attacks.
Several medical studies, says Kubzansky, have tracked heart attack patients for many months after they left the hospital. The studies found that the patients with diagnosable depression suffered more heart complications including death. In fact, the risk of death was almost four times higher in the first six months after a heart attack for the patients who were depressed.
Identifying the Risk Factors for Heart Disease
In the United States, heart disease is the number one killer of men and women. Each year over one million people have heart attacks. To help determine who may need more aggressive treatment after a heart attack, physicians assess each patient’s risk factors. Most known risk factors center around complications of the heart itself or predisposing traits like high cholesterol, smoking, diabetes or hypertension. Interest in the role of depression and mental health, however, opens up another avenue in the fight against heart disease and its complications. In light of the recent findings of depression as a risk factor, many doctors now recommend that all heart attack patients be screened for depression.
Finding the Connection
To understand why depression in heart attack patients may lead to worse complications, doctors look for common biologic patterns that connect the two. The current prevailing theory focuses on the balance of the actions of the nervous system. Part of the nervous system, called the autonomic nervous system, constantly regulates our internal organs without our awareness.
For example, we don’t need to tell our lungs to breathe or our hearts to beat. The autonomic nervous system does these things on its own. But if the autonomic nervous system is off-balance, many normal functions of the body are affected. Scientists note that patients with depression have distinctive changes in the balance of their autonomic nervous systems. Doctors believe these changes may underlie the connection between depression and heart disease.
If there is a biologic connection between depression and heart disease in people with weakened hearts, can depression also be a risk factor for heart disease in people with normal hearts? According to a recent medical review, this does indeed seem to be the case. But some scientists say the jury is still out on this issue.
As Kubzansky says, “There are studies on both sides of the fence. Some studies have said, ‘yes, depression is a risk factor for heart disease even if you haven’t had a heart attack and some studies have said ‘no,’” she continues. Ongoing research will hopefully clarify this question.
Treating Depression Effectively
For some heart attack patients, symptoms of depression may resolve without treatment. For others, whose symptoms persist, data sheds light on effective treatment. A large medical study showed that the antidepressant sertraline (Zoloft) causes no harm to the heart and can reduce symptoms of depression in people with heart disease.
Another large study of heart patients with depression, however, found that patients treated with psychotherapy had the same rate of heart complications as their counterparts who did not get psychotherapy. But, patients in this study who took antidepressant medications seemed to do a little better. The investigators call for further research to determine the best way to treat depression and reduce complications in heart attack patients.
In sum, any patient who has suffered a heart attack should discuss the risks of depression with their doctor. Likewise, patients with depression and no evidence of heart disease should be aware of all heart disease risk factors and should evaluate their individual risks with their physicians.
American Heart Association
Canadian Cardiovascular Society
Heart and Stroke Foundation of Canada
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Last reviewed March 2008 by Theodor B. Rais, MD
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