Here’s some depressing news: Women are twice as likely as men to experience clinical depression, and depressed women are two to three times as likely to develop heart disease as women who are not depressed.
Robert Carney, Ph.D., a certified cognitive therapist with Washington University Physicians, was one of the first researchers to study depression and mortality among heart disease patients. “We first studied this in the 1980s and found that those with both depression and heart disease are much more likely to have a bad outcome, especially following a heart attack, when risk increases anyway,” he says.
Carney’s more recent research explores why depression increases risk. One theory is that depression may be associated with particular biological abnormalities. For instance, depression could be linked in some way to subtle changes in the autonomic nervous system, causing people who are already vulnerable to heart disease to experience irregular heartbeats or an elevated heart rate. It also may be related to inflammatory markers, which researchers believe may be among the driving forces behind heart disease.
Yet another reason for the correlation could be that people who are depressed tend to lead less healthy lifestyles. “Depressed patients are often not good at adhering to a cardiac care treatment regimen. They’re less likely to exercise and more likely to smoke,” Carney says. “We’re finding lots of possible explanations, and they probably all play a role.”
Carney believes physicians should screen cardiac patients for depression. “We can’t say for certain that treating depression improves cardiac outcomes,” he says. “But if we can get people to adopt a more healthy lifestyle, that’s an important step. And treating depression improves quality of life.”
The first step in determining treatment should be an appropriate referral to a mental health professional, says Dr. Denise Janosik, a SLUCare cardiologist. But, she adds, although one small study showed fewer depressive symptoms in patients treated for depression after a heart attack, there are no data showing an improvement in death rates or recurrent heart attacks in those receiving depression treatment.
Janosik advises patients with depression to seek specialized treatment from a therapist or psychiatrist. “Cardiologists are focused on controlling the blood pressure and cholesterol to reduce recurrent heart attacks,” she says. “But if we don’t take into account the patient’s emotional state, we may be doing that person a disservice. Depression, anger and anxiety can be barriers to compliance with diet, exercise and medications and contribute to the risk of recurrent cardiac events.”
Dr. Anthony Pearson, a cardiologist with Cardiac Specialists of St. Luke’s Hospital, agrees that stress management and social support are helpful during cardiac rehabilitation. The value of more aggressive therapies is still unclear. “The largest study examining psychotherapy and antidepressant drug usage after heart attack to treat or mitigate depression did not show any benefit,” he notes.
Most cardiac rehab programs include some form of interpersonal support and stress control. Pearson notes that patients should “have the opportunity to talk on a regular basis with fellow cardiac patients and staff who can counsel and educate them,” which is beneficial following a serious cardiac event.
As researchers work to understand the relationship between heart health and mental health, cardiologists advise everyone, male and female, to talk with their physician about individual risk factors and preventive strategies. Seek medical attention if you experience any signs of early heart disease, such as shortness or breath, extreme fatigue, dizziness or irregular heartbeat. And if you feel depressed or anxious much of the time, get help.