The connection between heart disease and depression has been long established by the medical community — patients who have one of the two diseases are unfortunately predisposed to get the other one.
Now, a new study shows that patients who suffer from both heart disease and depression have twice the risk of dying compared with people who only have heart disease. The findings indicate this is true even in heart patients who were diagnosed with depression years after they were found to have heart disease.
“Depression, no matter how long it occurred after your coronary heart disease diagnosis, is a significant predictor of mortality,” says Heidi May, lead author of the study and a cardiovascular epidemiologist at Intermountain Medical Center Heart Institute in Salt Lake City. “It was actually a stronger predictor than other factors.”
The study, published in July in the European Heart Journal, examined 24,000 patients with heart disease and tracked them for 10 years. Depression was a more significant predictor of risk of dying than was age of the patient, the initial reason for the heart disease diagnosis, stroke, diabetes and kidney failure, the research shows.
May says the findings are significant in part because of the heavy toll heart disease takes across the nation. It’s the leading cause of death for both women and men in the United States, causing 1 in 4 deaths, according to the U.S. Centers for Disease Control and Prevention.
[See: Am I Just Sad — or Actually Depressed?]
A More Difficult Recovery
For some patients, depression predates heart disease. For others, heart disease may help trigger it. Experts say it’s not uncommon for depression to develop after patients find out they have heart disease, as the diagnosis can be overwhelming and lead to a period of fear, anxiety and sadness that at times does not abate.
The European Heart Journal study examined people who had a baseline of a heart disease diagnosis. The median timeframe for a depression diagnosis was four years after heart disease was discovered. About 15 percent of the heart patients tracked by May were diagnosed with depression at some point during the study, a number May says is “probably underdiagnosed.” The patients who were found to have depression were more often female, which did not surprise May because women in general are more often diagnosed with depression than men.
The study did not examine cause of death, but May points out that there are several factors to consider, including that depressed patients can have a harder time recovering from a heart attack or heart disease diagnosis. “It has been shown in other studies that depressed patients tend to not follow recommended treatment strategies. They are not as compliant with their medicines,[and] they don’t tend to follow diets recommended to them or the physical activity recommended for them,” May says. “These are generalities.”
[See: 6 Signs You’re Having a Heart Attack.]
She says that depression brings physiological changes, as well, including higher levels of inflammation, which has been associated with coronary artery disease, one form of heart disease. She adds that some studies show that when depression is successfully treated, the mortality risk drops.
Dr. Michael J. Severino, a cardiologist at Northwestern Medicine Central DuPage Hospital in Illinois, says the findings of the study were consistent with what he sees in his practice because the common combination of heart disease and depression can be devastating. “We don’t know exactly why,” Severino says.
But he offers some thoughts. “Depression is a nervous system disorder. It can cause hormonal imbalances, it can make people more susceptible to higher risks of heart attack,” Severino says. He notes that the medical community is still studying the relationship between depression and nerve cell function.
When Severino is forced to choose, he often treats depression before heart disease. Some drugs that treat abnormal heart rhythms don’t interact well with some antidepressants; taking both can cause heart rhythms to become more erratic and dangerous. Severino says that because antidepressants can be so critical to a patient’s recovery, he’ll generally recommend the patient stop the heart medication for a time. “The antidepressants usually win out,” he says.
He says he believes that “the brain and the heart are very closely linked,” adding, “I tell people that if your brain is functioning normally, you’re going to do better.”
[See: How to Avoid a Second Heart Attack.]
Mental Health Screenings for Heart Patients
It can be challenging for both heart patients and cardiologists to pick up on signs of depression, because many are common to both diseases. “Some of the symptoms of depression and heart disease overlap — being really tired, low energy, having trouble sleeping, difficulty carrying on your usual routine,” Severino says. He gives his patients a questionnaire as part of periodic screening for depression. If patients are flagged as possibly depressed, they’re referred to mental health professionals. The most common treatments for depression are medication and talk therapy.
Northwestern Memorial Hospital, which is part of the same medical group as Central DuPage, offers specialized mental health care for cardiac patients. Psychologist Kim L. Feingold, founder and director of Cardiac Behavioral Medicine at the Bluhm Cardiovascular Institute at Northwestern, works exclusively with cardiac patients. She helps them before and after surgery, plus helps them cope with the stress and anxiety that can accompany a new diagnosis. “It’s not uncommon for patients to experience depression following a cardiac event,” Feingold says. “We help them experience emotional growth out of a cardiac event instead of post-traumatic stress.”
May, the lead investigator of the study, says an important take-away from her findings is that patients need to be screened for depression not only at the onset of their heart disease or heart attack, but also in the following years as cardiac care continues. “I hope people will say, hey, depression is a really strong risk factor, and it may be uncomfortable to talk about, but it can significantly affect your health,” May says. “You need to be screened for it, and you might need to be treated for it.”
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Why Depression Might Double the Risk of Early Death for Heart Patients originally appeared on usnews.com
