Link Between Heart Disease and Depression

Can a man die of a broken heart? “Yes” says Dr Martin Cowie, consultant cardiologist at the National Heart and Lung Institute in London.

Most folk would have seen among their own friends, families and acquaintances (if not themselves!) how emotional stress can exacerbate heart disease and angina.

A 1969 study of 4500 widowers, all over 55 years, published in the British Medical Journal, revealed that for these men, the risk of dying in the first six months after they lost their spouse was 40% higher than expected. The single most common cause of these deaths was a heart attack.

A similar study in 1996 analysed statistics from a population of 1.5 million people between the ages of 35 and 84 – and found that the risk of dying from a heart attack in the first six months after losing a spouse was increased by 20 to 35%.

Depression linked to heart disease

Research studies have consistently shown that depression and heart disease are interlinked, with each being able to lead to the other. Just as depression can precipitate heart disease, so too can the development of heart disease result in depression, with all the psychological morbidity that this implies. Today, Depression is recognised as being an important risk factor for developing heart disease – just as serious a risk as having high blood pressure and elevated blood cholesterol.

A 1996 study conducted over a period of 14 years in Baltimore followed a group of 1551 people who were free of heart disease at the beginning of the study. It was found that those in this group who had a previous history of depression were four times more likely, compared to those who had no history of depression, to suffer a heart attack!

Another research study from Montreal found that heart patients who were depressed were four times as likely as those who were not depressed to die within the following six months.

Many similar research studies have shown that heart disease can follow the development of depression. Psychological distress can result in the blood pressure rising, the heart rate increasing, and blood clots forming more easily. People with depression may feel slowed down while paradoxically having high levels of stress hormones like adrenaline and steroids in their circulation – which can thus increase the workload of the heart.

Heart disease leading to depression

The original studies linking heart disease and depression found that people diagnosed with heart disease were more likely to suffer depression compared to otherwise healthy people. An interesting 1996 study by the same Montreal group mentioned above showed that, while in North America about 5% of the population at the time experienced major depression in a given year, this proportion increased to about 30% of people who had suffered a heart attack. And suffering from depression can make it harder for patients to take their heart medications properly and comply with their doctors’ advice.

Unfortunately, many patients being treated for their heart disease do not receive appropriate treatment for their concomitant depression. Heart specialists and general practitioners, unless they have a special interest or training in this field, often miss the diagnosis of depression – and even when they do recognize the symptoms, they often do not treat their heart patients’ depression adequately. Today we have new medications that can be used to treat depression quite effectively in many patients without causing the unpleasant side effects associated with the older anti-depressant drugs.

Interpersonal Therapy and Cognitive Behavioral Therapy

While modern anti-depressant medication is helpful in some patients for improving the symptoms and signs of depression, they are not the whole answer. Intervention in the form of Interpersonal Therapy (IT) and Cognitive Behaviour Therapy (CBT) has proved helpful in heart patients. Such therapy can also help to motivate patients to comply with taking their medication as well as changing their unhealthy lifestyles.

Physical exercise

Regular physical exercise provides another pathway that can help in reducing both depression and the risk of heart disease. A 1999 research study found, in a group of older patients diagnosed with major depression, that taking part in an exercise training programme was as good as antidepressant medication in improving their symptoms of depression. Since regular exercise is a major protective factor against heart disease, this form of exercise therapy has a doubly beneficial effect.

So just as much as emotional heartbreak can precipitate an actual heart attack, having a real heart attack can bring on psychological depression.

Observations like “It broke his heart when his life partner died” or “He seems so depressed after his heart attack”, are not without foundation.

They could well be providing the very medical diagnosis which is the crux of the problem.

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