Double Trouble: Depression and Heart Disease

Depression and heart disease frequently travel together. This common observation has generated the myth that depression is “normal” in the heart patient. Buying into this concept, many doctors ignore a heart patient’s depression, focusing only on the cardiac problem. This is a mistake.

Two leading health problems

Clinical depression and cardiovascular disease are the two leading causes of disability worldwide. When they coexist in the same patient, they create a synergy that makes both conditions worse. At any given time, about 5 percent of people in the general population are suffering from depression. Unfortunately, we have more bad news for them. Their depression is associated with increased risk of developing coronary heart disease over time.

How does depression lead to coronary heart disease?

We don’t have a concrete answer to this question, but we have some good leads. Depressed individuals often have unfavorable changes in blood pressure, blood clotting, inflammation and circulating stress hormones, all factors associated with coronary heart disease. In addition, lifestyle factors in the depressed person, including, poor diet, smoking and lack of exercise, increase the risk of developing heart disease.

Whatever the explanation for the association between depression and heart disease, the message is clear. If a friend or loved one suffers from depression, encourage both treatment of depression and a heart healthy lifestyle to ward off coronary heart disease.

Heart patients are prone to depression

As if having a heart issue were not enough, it turns out that 20 to 30 percent of all heart patients develop depression. This startling figure has led many physicians to assume that depression is normal in people with heart disease. After all, they reason, anybody would be upset and depressed to discover he had heart disease. They also assume that the depression will get better on its own with time. But both of those beliefs are wrong. Depression is common in people with heart disease, but it is not normal.

Depressed heart patients fare poorly

Depressed heart patients experience more heart attacks and a higher risk of death than their non-depressed counterparts. After a heart attack, depression substantially increases the risk of having another heart attack and the risk of dying within six months. We see similar trends after bypass surgery. And the worse the depression, the worse the cardiac outlook.

What you can do

Doctors, nurses, and family members may ignore heart patients’ complaints of feeling sad, empty, and listless, often attribute these feelings to the heart problems, and consequently failing to recognize a loved one’s depression. But you can recognize depression. The American Heart Association recommends that everyone with heart disease should be screened for depression with two simple questions:

  1. During the past month, have you frequently felt down, depressed or hopeless? 2. During the past month, have you felt little interest or pleasure in doing things?

If you or a loved one has heart disease-newly diagnosed or chronic-see your doctor for help if the answer to either one of these questions is yes. You will be glad that you did.

Reprinted from:

Psychology Today

February, 2012

Marc Gillinov, M.D.