Heart disease and depression are often found in the same individuals. In fact, one study found depression to be three times more common among patients with heart disease than in those without. In addition, about fifteen to thirty percent of heart diseases patients have significant depression symptoms. And, among heart attack patients, the prevalence of depression is quite high, with about forty percent of younger women (less than sixty years old) having it.
Why Are Depression and Heart Disease Linked?
Although it is not known exactly why depression and heart disease are linked, several different hypotheses have been put forth to explain it:
- Depression may affect heart disease risk by limiting a person's ability and motivation to live a healthy lifestyle and practice good self-care.
- Depression may create hormonal changes which lead to increased blood pressure, heart rate and plasma glucose; insulin resistance; and high blood cholesterol, which are all risk factors for heart disease.
- Depression may create autonomic nervous system dysfunction. This system controls a number of bodily functions, such as heart rate and blood pressure.
- Depression may cause enhanced platelet activity, leading to easier formation of blood clots.
- The psychological stress of depression may cause endothelial dysfunction, eventually leading to hardening of the arteries.
- Chronic inflammation in the body could be responsible for both depression and heart disease.
- Certain genes may be responsible for both depression and heart disease.
Why Is This Link Important?
It is important to recognize the link between depression and heart disease because a timely diagnosis can help patients get the treatment that they need, improving their quality of life and making it easier for them to adhere to their treatment regimen and make any necessary lifestyle changes.
It is unknown whether treatment might also help the patient's heart disease, but the aforementioned benefits to treatment adherence and quality of life still make detection and treatment an important goal.
Do You Need to Be Treated for Depression?
It is very easy to determine if a patient might require professional evaluation and treatment for depression. The American Heart Association has narrowed it down to asking two simple questions:
- During the past month, have you frequently felt down, depressed or hopeless?
- During the past month, have you felt little interest or pleasure in doing things?
If you have heart disease and you answered "yes" to either of these questions, consider asking your doctor about the possibility that you may need treatment for depression.
How Is Depression Treated When You Have Heart Disease?
The most common treatments for depression when you have heart disease are:
- Cognitive behavioral therapy: Cognitive behavioral therapy is a type of psychotherapy which aims to helps people by teaching them to recognize and avoid certain negative thinking patterns which contribute to feelings of depression.
- Antidepressants: The most commonly utilized antidepressants for the treatment of depression with concurrent heart disease are selective serotonin reuptake inhibitors (SSRIs) - such as Prozac (fluoxetine), Celexa (citalopram) and Zoloft (sertraline) - and serotonin and norepinephrine reuptake inhibitors (SNRIs) - such as Effexor (venlafaxine) and Cymbalta (duloxetine).
Your doctor may also recommend certain lifestyle change which may benefit both your heart disease and your depression. These include:
- Eating a healthy diet
- Getting regular exercise
- Cutting down your alcohol consumption, or avoiding it altogether
- Quitting smoking
Bonow, Robert O. et. al. Braunwald's Heart Disease - A Textbook of Cardiovascular Medicine. 9th ed. Saunders Elsevier: Philadelphia, 2011.
"Depression and Heart Disease." National Institute of Mental Health. Revised 2011. National Institutes of Health. Accessed: January 21, 2013.
Stern, Theodore A. et. al. Massachusetts General Hospital Comprehensive Clinical Psychiatry. 1st ed. Mosby Elsevier: Philadelphia, 2008.