It's long been known that depression and heart disease have a strong connection. Depressed people have a higher risk of developing heart disease, and heat disease patients have a higher risk of becoming depressed. Why is this? Let's explore the connection.
How heart disease can lead to depression
It really isn't that much of a surprise that heat disease leads to a higher risk of depression — people suffering from heart disease have been confronted with a clinical entity that isn't just potentially life-threatening, but also often leads to long-term life changes. Suffering from heart disease can easily lead to:
- Frustration over not being able to do the things that you once were — including, in some cases, working
- Fear of dying
- A negative self-image as your physical abilities have changed
- Guilt over lifestyle changes you have made in the past, such as smoking or unhealthy eating, that may have contributed to your heart disease
Some factors may decrease a heart disease patient's risk of falling into depression:
- Having a supportive healthcare team
- Working on positive changes for a better life (such as attending a cardiac rehabilitation program)
- Getting the love and support you need from your family and friends
When a heart disease patient does become depressed, however, it's important for them to access treatment as soon as possible. Being depressed can lead to worse heart health outcomes, among other reasons because it means patients are less likely to stick to their medications or engage in healthy eating and physical activity.
SSRI antidepressants are the most common choice for heart failure patients who are also depressed, for instance, but a combination of tricyclic antidepressants and beta blockers appears to lead to better outcomes than a combination of beta blockers and SSRIs. Patients with acute coronary syndrome are, meanwhile, most likely to be advised to take citalopram, sertraline, or fluoxetine.
In addition to antidepressants, talk therapy and positive life changes — including cardiac rehab — can play an important role in the treatment of depression for patients who also have heart disease.
Can depression also cause heart disease?
This is, perhaps, the more interesting question. Depression is known to be a predictive factor for coronary heart disease, but why?
Some surface-level explanations include the idea that depressed people are more likely to smoke, and smoking strongly contributes to a person's risk or heart disease, that they are more likely to abuse alcohol, and less likely to be physically active healthy eaters. There's more to the link than this, though.
Because studies also found that losing one parent to heart disease increases a person's risk of becoming depressed, the possibility that genetic factors could be to blame for the link between depression and heart disease was explored. When this didn't appear to be the case, environmental factors were examined next.
What was uncovered is rather fascinating — it appeared that high triglyceride levels and two inflammatory proteins (IL-6 and CRP) didn't just pose an increased risk of heart disease, but also depression. These markers are also often present in people suffering from treatment-resistant depression (which doesn't respond well to the most common treatments for depression).
The conclusion? The authors of a fascinating study investigating the link between depression and coronary heart disease said:
"With regards to shared environmental factors, the depression–CHD comorbidity could be linked with early-life factors influencing inflammatory regulation, such as impaired fetal development or childhood maltreatment."
Depression and heart disease can share important risk factors, in other words. The common link is inflammation. In future, this finding could lead to novel preventative and treatment strategies, with the study authors suggesting that anti-inflammatory medications could be used in the treatment of (treatment-resistant) depression.
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