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Depression may Cause Heart Disease and Related
Death
Previous research has already suggested that there a two-directional
link between depression and health conditions of the heart.
A recent study published in the Journal of the American
College of Cardiology has added to the body of evidence, having found that
being depressed could increase the likelihood that a person gets hit or killed
by heart disease.
Details of Study
The study team, comprising members from the Columbia University Medical
Center in New York, University of California, Berkeley, Harvard Medical School
in Boston, as well as the Harvard School of Public Health in Boston, had
followed 63,469 women who were part of the Nurses' Health Study; the study
subjects were free from cardiovascular disease at the start of the exercise.
Questionnaires were used in 1992, 1996 and 2000 to obtain information on
symptoms of depression, while data on antidepressant use was collected in 1996
and 2000. Outcomes looked at were sudden cardiac death, fatal coronary heart
disease, and nonfatal myocardial infarction.
Findings of Study
The Mental Health Index (MHI-5) was used to assess the women's symptoms
in 1992, and the scale predicted that 7.9% of them had clinical depression. The
researchers also found that symptoms of depression were associated with events
of coronary heart disease. After controlling for other risk factors for the
condition, it was found that those with such symptoms had 49% higher risk of
fatal coronary heart disease.
In post-1996 models, the study team used a proxy variable for clinical
depression, which consisted of severe depressive symptoms and / or the use of
antidepressants, and they found that depressed women had 133% higher risk of
sudden cardiac death. This risk could be mainly attributed to the relationship
between the use of antidepressants and sudden cardiac death (234% higher risk).
The latter finding is somewhat of a surprise. There are two main
possibilities for it - that the use of antidepressants was indicative of women
who suffered the worst bouts of depression, which would make sense, or that
antidepressants could themselves be contributing to heart problems, which would
be bad news. This is especially since antidepressants already have a number of
other known side effects. More research into this area will be needed.
William Whang, MD, the leader of the study, said that his team's
findings add to growing research which shows depression as an independent risk
factor for cardiovascular disease, on top of already well-established ones like
smoking, hypertension and unhealthy cholesterol levels. And, in fact, the
Nurses' Health Study, which covered mainly white females, may understate the
risk. "If anything, the impact in African-American women is probably greater,"
he said. According to him, future research should check out whether proper
treatment of depression would lower the risk of negative heart outcomes.
Other Research
The same applies to males too, according to a study recently presented
at the American Psychosomatic Society's annual meeting. In that study,
information on over 1,200 male twins who had been in the US military during the
Vietnam War was used. The men were surveyed on various health issues, including
depression, in 1992 and then again in 2005. The researchers found that men who
were depressed in 1992 had twice the risk of getting heart disease in the
following years, as compared to those who did not suffer from the condition.
Jeffrey F Scherrer, PhD, a research assistant professor of psychiatry at
the Washington University School of Medicine and the St. Louis Veterans Affairs
Medical Center, summed up his team's research when he said: "Based on our
findings, we can say that after adjusting for other risk factors, depression
remains a significant predictor of heart disease."
The Depression-Heart Disease Link
After suffering a serious ailment like a heart attack or a stroke, it is
easy to slump into a period of depression. This is especially so if the patient
is required to make certain drastic changes to his lifestyle and dietary habits.
No more smoking, drinking, or eating their favorite foods, for example. Some may
even suffer from loss of vital bodily functions, due to partial or full
paralysis. Under such circumstances, it is natural to feel down.
But how does depression affect heart health? In the first study, it had
been discovered that women who had worse symptoms of depression had a higher
likelihood of also having other risk factors for heart disease. In addition,
emotional stressors such as depression could cause elevated resting heart rates,
making the heart work harder.
Further, depressed persons are more likely to neglect their own health
and wellbeing. This may include not eating properly, failing to exercise, and
not resting well.
And we cannot rule out the possibility of a vicious cycle taking place,
whereby heart disease patients fall into depressive states and then become more
likely to suffer worsening heart outcomes. It is thus very important that the
depression-heart health link be taken seriously.
Indeed, the American Heart Association had recently made the
recommendation that persons who suffer from heart disease undergo regular checks
for depression. This is something which you and your loved ones should take note
of, and heart patients should be carefully observed for any possible symptoms of
depression.
References
Whang W et al. Depression and Risk of Sudden Cardiac Death and Coronary
Heart Disease in Women. Journal of the American College of Cardiology
2009;53:950-958.
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