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Hopelessness and the Heart Attack: The Role of Depression in Heart Disease

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Image for MI mortality article “Everybody obviously has a mood dip after a heart attack ,” says Laura Kubzansky, PhD, MPH, an assistant professor of society, human development, and health at Harvard University. But in studies, she says, heart attack victims diagnosed with depression fared significantly worse than heart attack victims without signs of depression. Interestingly, these studies suggest that many of these depressed patients were never depressed or treated for depression before they had heart attacks.
Several studies, says Kubzansky, have tracked heart attack patients for many months after they left the hospital. The studies found that the patients with diagnosable depression suffered more heart complications including death.

Identifying the Risk Factors for Heart Disease

In the United States, heart disease is the number one killer of men and women. To help determine who may need more aggressive treatment after a heart attack, doctors assess each patient’s risk factors. Most known risk factors center around complications of the heart itself or predisposing traits, like high cholesterol , smoking , diabetes and high blood pressure . Interest in the role of depression and mental health, however, opens up another avenue in the fight against heart disease and its complications. In light of findings of depression as a risk factor, many doctors now recommend that all heart attack patients be screened for depression.

Finding the Connection

To understand why depression in heart attack patients may lead to worse complications, doctors look for common biologic patterns that connect the two. The current prevailing theory focuses on the balance of the actions of the nervous system. Part of the nervous system, called the autonomic nervous system, constantly regulates our internal organs without our awareness.
For example, we don’t need to tell our lungs to breathe or our hearts to beat. The autonomic nervous system does these things on its own. But if the autonomic nervous system is off-balance, many normal functions of the body are affected. Scientists note that patients with depression have distinctive changes in the balance of their autonomic nervous systems. Some believe these changes may underlie the connection between depression and heart disease.
If there is a biologic connection between depression and heart disease in people with weakened hearts, can depression also be a risk factor for heart disease in people with normal hearts? According to a medical review, this does indeed seem to be the case.

Treating Depression Effectively

For some heart attack patients, symptoms of depression may resolve without treatment. For others, whose symptoms persist, data sheds light on effective treatment. A large medical study showed that the antidepressant sertraline (Zoloft) causes no harm to the heart and can reduce symptoms of depression in people with heart disease.
Another large study of heart patients with depression, however, found that patients treated with psychotherapy had the same rate of heart complications as their counterparts who did not get psychotherapy. But patients in this study who took antidepressant medicines seemed to do a little better. The investigators call for further research to determine the best way to treat depression and reduce complications in heart attack patients.
In sum, any patient who has suffered a heart attack should discuss the risks of depression with their doctor. Likewise, patients with depression and no evidence of heart disease should be aware of all heart disease risk factors and should evaluate their individual risks with their doctors.

RESOURCES

American Heart Association http://www.americanheart.org/

Family Doctor http://www.familydoctor.org/

CANADIAN RESOURCES

Canadian Cardiovascular Society http://www.ccs.ca/home/index%5Fe.aspx/

Heart and Stroke Foundation of Canada http://www.heartandstroke.com/

References

Berkman LF, Blumenthal J, Burg M, et al. Enhancing recovery in coronary heart disease patients investigators (ENRICHD). Effects of treating depression and low perceived social support on clinical events after myocardial infarction. The enhancing recovery in coronary heart disease patients (ENRICHD) randomized trial. JAMA.  2003;289:3106-3116.

Carney RM, Blumenthal JA, Stein PK, et al. Depression, heart rate variability, and acute myocardial infarction. Circulation . 2001;104:2024-2028.

Carney RM, Freedland KE, Miller GE, et al. Depression as a risk factor for cardiac mortality and morbidity: a review of potential mechanisms [Abstract]. J Psychosom Res . 2002;53:897-902.

Frasure-Smith N, Lesperance F, Talajic M. Depression and 18-month prognosis after myocardial infarction. Circulation . 1995;91;999-1005.

Glassman AH, O'Connor CM, Califf RM, et al. Sertraline antidepressant heart attack randomized trial (SADHEART) Group. Sertraline treatment of major depression in patients with acute MI or unstable angina. JAMA . 2002;288(6):701-9.

Heart attack and angina statistic. American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=4591 . Accessed April 15, 2008.

Heart disease and stroke statistics—2003 update. American Heart Association website. Available at: http://www.americanheart.org . Accessed August 20, 2003.

Lauzon C, Beck CA, Huynh T, et al. Depression and prognosis following hospital admission because of acute myocardial infarction. CMAJ . 2003;168:547-552.

Wulsin LR, Singal BM. Do depressive symptoms increase the risk for the onset of coronary disease? A systematic quantitative review. Psychosom Med . 2003;65:201-210.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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