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

    Image for MI mortality article It's normal to feel down after a heart attack, but symptoms of depression can compound your recovery. Studies support that people who had heart attacks and were diagnosed with depression fared significantly worse than those without signs of depression. Other studies have tracked heart attack patients for several months after they left the hospital. Those studies found that the patients with diagnosable depression suffered more heart complications, including death.
    How does this affect you? It translates to better care if you have a heart attack. Depression and how to treat it are incorporated into the heart attack recovery process.

    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, a move supported by the American Heart Association and American Psychiatric Association.

    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 causes no harm to the heart and can reduce symptoms of depression in people with heart disease.
    Patients that had access to treatment for depression had better recovery outcomes than those that did not. Patients with access had improved depressive symptoms, reduced numbers of second heart attacks, and less complications.
    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 Academy of Family Physicians http:/.familydoctor.org

    American Heart Association http://heart.org

    CANADIAN RESOURCES

    Canadian Cardiovascular Society http://www.ccs.ca

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

    References

    Acute coronary syndrome. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 6, 2014. Accessed January 8, 2014.

    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.

    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 patients should be screened, treated for depression. American Heart Association website. Available at: http://newsroom.heart.org/news/heart-patients-should-be-screened-226837. Published September 29, 2008. Accessed January 8, 2014.

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

    ST-elevation myocardial infarction. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 6, 2014. Accessed January 8, 2014.

    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.

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