Understanding the link between depression and heart disease

According to the American Heart Association, one in 10 Americans, age 18 and older, have depression. Symptoms of depression are about three times more common in patients after an acute heart attack than in the general population, which strongly suggests a link between depression and heart disease.

While being diagnosed with heart disease or having a heart attack may increase the risk of depression, depression itself may increase the chances of developing heart disease.

According to University of Iowa cardiologist Milena A. Gebska, M.D., Ph.D., a number of factors may explain why patients with depression are at a higher risk for heart disease.

“There is a two-way relationship between heart disease and depression,” Gebska says. “On one hand, depression itself is an independent risk factor for adverse cardiac events in patients without known heart disease. On the other hand, patients with known heart disease, particularly those who develop a heart attack, are at increased risk of developing new diagnosis of depression.”

Gebska says it is somewhat difficult to prove that heart disease directly leads to a patient's first-ever episode of depression since many patients may have not been formally diagnosed with depression prior to the cardiac event.

"However, from a medical perspective, we can say with certainty that both depression and heart disease often coexist," Gebska says.

In fact, emotional distress and depression were recently identified as new risk factors for coronary artery disease (blockages in the heart vessels).

Common lifestyle habits brought upon by depression are similar to traditional cardiovascular risk factors. These include a sedentary lifestyle, obesity, smoking, poor diet and overeating, and excessive alcohol consumption. Skipping important medications also plays a role.

Interestingly, gender differences in patients with heart disease and depression are well recognized. Women younger than age 55 who have both depression and premature coronary artery disease are at the highest risk for poor cardiovascular outcomes, including death, compared with young men or older women, Gebska notes.

Medications that help treat mental disorders may also account for an increase in heart disease risk. Certain medications may increase weight gain, thereby putting a greater burden on the arteries, increasing blood pressure, and contributing to the development of risk factors related to heart disease.

If these side effects occur, do not change or stop taking psychiatric medication without consulting your physician. Changes in specific medication combinations and doses may be all that is needed, according to Gebska.

Depression: a genetic and environmental disease

A number of factors may lead a person to depression. In fact, depression is caused by a combination of genetic, biological, environmental, and psychological factors. These factors potentially may explain why younger women with depression and heart disease do worse compared with younger men.

Women play an important role in many families. As a result, they may face more everyday stressors, struggle to find balance between work and home duties, and find themselves more prone to inflammatory conditions. Recent medical literature also suggests that women may respond physiologically to stress and depression differently than men.

The good news is that recovering from and living with depression is possible. Over time, this can help improve your overall health and decrease your risk of heart disease.

“Treatment of depression has been shown to improve patients' quality of life. There are also preliminary results suggesting a trend to better cardiovascular prognosis with antidepressive treatment in patients with heart disease,” Gebska says.

Being diagnosed with heart disease or having a heart attack may be overwhelming and cause anxiety or depression in patients. It is important to address these issues in a healthy way. If you feel depressed or anxious, it is important that you share this with your doctor and work together on a plan.

The following lifestyle changes can help manage both depression and heart disease:

• Eat healthful foods: A balanced diet will make you feel better, improve the health of your heart, and decrease your risk of heart disease.
• Exercise regularly: Exercise is a great form of therapy for people with depression and helps improve your heart health at the same time.
• Drink less alcohol: As a depressant, alcohol lowers the levels of serotonin (the chemical that regulate mood) in your brain. Hence, heavy alcohol consumption may cause your depression to worsen. Alcohol also increases the risk of high blood pressure, a major risk factor for heart attack or stroke. The American Heart Association recommends one to two drinks or less per day for men and one drink or less per day for women.
• Quit smoking: Many people who are depressed resort to smoking as a form of relaxation. Smoking is the number one preventable risk factor for developing heart disease. In other words, you can lower your chances of developing heart disease if you kick the habit. Talk with your doctor about healthier relaxation techniques.

To lower stress levels and help prevent or treat depression, the following can help:

• Do deep breathing exercises
• Use visualization (imagining beautiful settings, favorite memories)
• Get plenty of rest and sleep
• Share your feelings with others or write them down

A final note

Treating depression is as important as treating any other medical condition. If you or someone you know is depressed, the most important thing to do is find the best treatment option. Consulting a mental health care provider is the first step.