Provided by the National Institute of Mental Health
Research over the past two decades has shown that
depression and heart disease are common companions and, what is worse, each can
lead to the other. It appears now that depression is an important risk factor
for heart disease along with high blood cholesterol and high blood pressure. A
study conducted in Baltimore, MD found that of 1,551 people who were free of
heart disease, those who had a history of depression were four times more likely
than those who did not to suffer a heart attack in the next 14 years.1 In
addition, researchers in Montreal, Canada found that heart patients who were
depressed were four times as likely to die in the next 6 months as those who
were not depressed.2
Depression may make it harder to take the medications needed and to carry out
the treatment for heart disease.3 Depression also may result in chronically
elevated levels of stress hormones, such as cortisol and adrenaline, and the
activation of the sympathetic nervous system (part of the "fight or flight"
response), which can have deleterious effects on the heart.4
The first studies of heart disease and depression found that people with heart
disease were more likely to suffer from depression than otherwise healthy
people.4 While about 1 in 20 American adults experience major depression in a
given year, the number goes to about one in three for people who have survived a
heart attack.5,6 Furthermore, other researchers have found that most heart
patients with depression do not receive appropriate treatment. Cardiologists and
primary care physicians tend to miss the diagnosis of depression;4 and even when
they do recognize it, they often do not treat it adequately.7
The public health impact of depression and heart disease, both separately and
together, is enormous. Depression is the estimated leading cause of disability
worldwide8, and heart disease is by far the leading cause of death in the United
States.9 Approximately one in three Americans will die of some form of heart
disease.
Studies indicate that depression can appear after heart disease and/or heart
disease surgery. In one investigation, nearly half of the patients studied one
week after cardiopulmonary bypass surgery experienced serious cognitive
problems, which may contribute to clinical depression in some individuals.10
There are also multiple studies indicating that heart disease can follow
depression.4 Psychological distress may cause rapid heartbeat, high blood
pressure, and faster blood clotting. It can also lead to elevated insulin and
cholesterol levels. These risk factors, with obesity, form a constellation of
symptoms and often serve as a predictor of and a response to heart disease.
People with depression may feel slowed down and still have high levels of stress
hormones. This can increase the work of the heart. As high levels of stress
hormones are signaling a "fight or flight" reaction, the body's metabolism is
diverted away from the type of tissue repair needed in heart disease.
Regardless of cause, the combination of depression and heart disease is
associated with increased sickness and death, making effective treatment of
depression imperative. Pharmacological and cognitive-behavioral therapy
treatments for depression are relatively well developed and play an important
role in reducing the adverse impact of depression.4 With the advent of the
selective serotonin reuptake inhibitors to treat depression, more medically ill
patients can be treated without the complicating cardiovascular side effects of
the previous drugs available. Ongoing research is investigating whether these
treatments also reduce the associated risk of a second heart attack.
Furthermore, preventive interventions based on cognitive-behavior theories of
depression also merit attention as approaches for avoiding adverse outcomes
associated with both disorders. These interventions may help promote adherence
and behavior change that may increase the impact of available pharmacological
and behavioral approaches to both diseases.
Exercise is another potential pathway to reducing both depression and risk of
heart disease. A recent study found that participation in an exercise training
program was comparable to treatment with an antidepressant medication (a
selective serotonin reuptake inhibitor) for improving depressive symptoms in
older adults diagnosed with major depression.11 Exercise, of course, is a major
protective factor against heart disease as well.12
The NIMH and the National Heart, Lung and Blood Institute are invested in
uncovering the complicated relationship between depression and heart disease.
They support research on the basic mechanisms and processes linking co-occurring
mental and medical disorders to identify potent, modifiable risk factors and
protective processes amenable to medical and behavioral interventions that will
reduce the adverse outcomes associated with both types of disorders.
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For More Information
Please visit the following links for more information about organizations that
focus on depression and heart disease.
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All material in this fact sheet is in the public domain and may be copied or
reproduced without permission from the Institute. Citation of the source is
appreciated.
NIH Publication No. 01-4592
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References
1 Pratt LA, Ford DE, Crum RM, et al. Depression, psychotropic medication, and
risk of myocardial infarction. Prospective data from the Baltimore ECA
follow-up. Circulation, 1996; 94(12): 3123-9.
2 Frasure-Smith N, Lesperance F, Talajic M. Depression and 18-month prognosis
after myocardial infarction. Circulation, 1995; 91(4): 999-1005.
3 Ziegelstein RC, Fauerbach JA, Stevens SS, et al. Patients with depression are
less likely to follow recommendations to reduce cardiac risk during recovery
from a myocardial infarction. Archives of Internal Medicine, 2000; 160(12):
1818-23.
4 Nemeroff CB, Musselman DL, Evans DL. Depression and cardiac disease.
Depression and Anxiety, 1998; 8(Suppl 1): 71-9.
5 Regier DA, Narrow WE, Rae DS, et al. The de facto mental and addictive
disorders service system. Epidemiologic Catchment Area prospective 1-year
prevalence rates of disorders and services. Archives of General Psychiatry,
1993; 50(2): 85-94.
6 Lesperance F, Frasure-Smith N, Talajic M. Major depression before and after
myocardial infarction: its nature and consequences. Psychosomatic Medicine,
1996; 58(2): 99-110.
7 Hirschfeld RM, Keller MB, Panico S, et al. The National Depressive and
Manic-Depressive Association consensus statement on the undertreatment of
depression. Journal of the American Medical Association, 1997; 277(4): 333-40.
8 Murray CJL, Lopez AD, eds. Summary: The global burden of disease: a
comprehensive assessment of mortality and disability from diseases, injuries,
and risk factors in 1990 and projected to 2020. Cambridge, MA: Published by the
Harvard School of Public Health on behalf of the World Health Organization and
the World Bank, Harvard University Press, 1996. http://www.who.int/msa/mnh/ems/dalys/intro.htm
9 Murphy SL. Deaths: final data for 1998. National Vital Statistics Report,
48(11). DHHS Publication No. 2000-1120. Hyattsville, MD: National Center for
Health Statistics, 2000. http://www.cdc.gov/nchs/data/nvs48_11.pdf
10 Chabot RJ, Gugino LD, Aglio LS, et al. QEEG and neuropsychological profiles
of patients after undergoing cardiopulmonary bypass surgical procedures.
Clinical Electroencephalography, 1997; 28(2): 98-105.
11 Blumenthal JA, Babyak MA, Moore KA, et al. Effects of exercise training on
older patients with major depression. Archives of Internal Medicine, 1999;
159(19): 2349-56.
12 Fletcher GF, Balady G, Blair SN, et al. Statement on exercise: benefits and
recommendations for physical activity programs for all Americans. A statement
for health professionals by the Committee on Exercise and Cardiac Rehabilitation
of the Council on Clinical Cardiology, American Heart Association. Circulation,
1996; 94(4): 857-62.
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