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Depression and Heart Disease

Updated: Feb 5, 2019

Most physicians and many patients are keenly aware of the dangers of heart disease. It is in fact the number one cause of death in the world. Unfortunately the majority of health care providers are entirely unaware of the effects of mental health on the development of heart disease and various outcomes from heart disease-related complications. It has only been within the past decade that researchers have begun to understand the devastating cardiovascular complications of emotional diseases, especially depression, and even more recently that clinicians have begun to treat these mental disorders in order to improve patient’s heart health.

The numbers documenting the increased risks associated with depression and heart disease are staggering. Twenty percent of people will have an episode of major depression during their lifetime. Almost half of patients with significant cardiovascular disease will have clinical depression in their lifetime. That is an increased risk of over 100%!

This information is even more startling when you consider that the risk of a patient dying from heart disease is significantly increased in patients suffering from depression. Some data has shown that males with depression have evidence of more blockages in their coronary arteries when they suffer from depression than those who do not. Some international studies have suggested that depression should be considered an independent risk factor for a heart attack – similar to diabetes, high cholesterol, and smoking, - this however has not yet been accepted into common practice.

The link between heart disease and depression is the subject of intense research in both the laboratory and in schools of public health and psychiatry. Certain neurotransmitters in the brain, such as serotonin, are involved in maintaining emotional balance but also have important effects on both the cardiovascular and immune systems. These effects mainly involve the development of plaques in the heart’s arteries which may lead to blockages and then heart attacks. Other scientists theorize that patients with untreated depression are more apt to make bad lifestyle choices, such as smoking and an unhealthy diet, which puts the body at greater risk for heart disease.

These theories may be reflected in newer research which shows that patients who have undergone bypass surgery have a significant increased risk for their new grafts to develop blockages if they suffer from depression. Since presumably the patient’s have only had their grafts for only a few years this may suggest the potentially rapid association depression may have with the development of heart disease.

Despite a wealth of information regarding the association between heart disease and depression many health care providers do a poor job of recognizing the clinical signs and symptoms of depression and then fail to treat the condition appropriately. The most common drug prescribed to patients with clinical depression, a selective serotonin reuptake inhibitor (SSRI), is tolerated well in patients with underlying heart disease. Therefore there usually is not a medical reason why a patient with both conditions could not be appropriately and successfully treated for their heart disease.

It is therefore of utmost importance to discuss any previous history of mental health problems, especially depression, with your doctor. You may find that by addressing two health problems that are seemingly unrelated you will increase you chances for a long heart-healthy life!

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