Depression, Heart Attack, and Stroke

It is not uncommon for a person to experience bouts of depressive symptoms after enduring a terrifying ordeal such as a heart attack or stroke. During the recovery process, many people will begin to demonstrate signs of depression—an illness that affects about 350 million people worldwide, 19 million in the United States. Major depressive disorder (or clinical depression) occurs when feelings of hopelessness and sadness become chronic. Other symptoms may include insomnia, change in appetite, loss of interest in daily activities, physical pain, and thoughts of suicide.

Likewise, living with a depressive disorder can increase a person’s risks for developing many health issues. Depression has been linked to an array of serious, often life-threatening illnesses. The consequences of depression happen for two main reasons: 1. Depression can lead to an apathetic and uncooperative lifestyle, which causes a person to neglect routine health precautions; and 2. The neurotransmission (the chemical messages of the brain) of people with depression may negatively impact various parts of the body, leading to chronic pain, inflammation, and poor blood flow.  These latter symptoms are what concern many medical and mental health professionals. 

Depression = Inflammation + Decreased Blood Flow

In particular, inflammation and decreased blood flow can result in two deadly and debilitating events: heart attack and stroke. Unmonitored and persistent depression is taxing on the body and may lead to cardiac disease, which amplifies a person’s risk of heart attack and stroke. People with depression are more apt to smoke, have unhealthy diets, and remain sedentary. These issues can lead to a host of issues that increase the probability of developing cardiac disease, including high blood pressure, obesity, stress, diabetes, and cholesterol.

Many researchers have attempted to combat cardiovascular disease through treating depression because of its prevalence in cardiac patients. Unfortunately, many studies lack the proper evidence that provides the medical community with clear treatment plans. In most cases, depression treatment is positive in that it may enhance a person’s quality of life, but researchers are befuddled that it hasn’t shown the desired outcomes of alleviating cardiovascular symptoms. So investigators have had to approach the issue from a different angle: if depression is a risk factor for cardiovascular disease, can preventing depression also prevent heart attack and stroke?

A New Scientific Study

In a study conducted through the School of Science at Indiana University-Purdue University Indianapolis, researchers have discovered a significant relationship between treating depression (in patients without cardiovascular issues) and diminishing the chances of heart attack and stroke. The researchers randomly assigned 235 older patients with clinical depression to two groups: one with collaborative care that included treatment for depression and one with traditional care, without depression treatment. The collaborative care included psychotherapy and the use of antidepressants. Of this sample, 168 participants had no prior symptoms of cardiovascular disease, while the remaining 67 did. The results were promising.

Patients without preexisting cardiac disease, who received the collaborative care, were 48% less likely to endure a heart attack or stroke over an 8-year period. The results did not indicate the same outcome for those that received traditional care without depression treatment. Discouragingly, no change in risk factor occurred for patients with preexisting cardiovascular disease.

These results are significant, because they signify the importance of preventing and treating depression before it leads to other illnesses, specifically cardiovascular disease. Nevertheless, other risk factors for cardiovascular disease exist without the presence of depression. Researchers suggest that physicians and mental health professionals approach treatment in a holistic manner—dealing with blood pressure, cholesterol, weight, smoking, as well as depression. In other words, depression plays a formidable role in the onset of cardiovascular disease, and its prevention and treatment should be a priority.

Therapy, SSRI's, and Electroshock!

Beyond psychotherapy (talk therapy), antidepressants and electroconvulsive therapy are two treatments for depression that may also help improve cerebral blood flow, both directly and indirectly. Studies have already revealed an association between decreased cerebral blood flow and depression, so researchers wanted to know if increasing blood flow in the brain would improve symptoms of depression. By using molecular imaging/nuclear medicine, scientists at the Department of Psychiatry at Hadassah-Hebrew University Medical Center in Jerusalem, Israel, have discovered that increased blood flow does alleviate signs of depression. Most antidepressants promote cerebral blood flow; however, electroconvulsive treatment exacerbates diminished blood flow. So how is this second treatment beneficial?

The study’s findings indicate that people who do not respond well to antidepressants typically respond well to electroconvulsive treatment. Even though brain imaging techniques revealed decreased blood flow by using this therapy, images also demonstrated that as depression symptoms improved, so did blood flow. More research must be conducted to fully understand how patients respond differently to various therapies, but the initial findings are assuring. By identifying proper treatments for individuals with depression, specific treatments can help ameliorate symptoms of depression by improving blood flow. In turn, this outcome can benefit people susceptible to enhanced risks of heart attack and stroke. 

Melissa Lavery, M.S.

References

Depression. (2012, October 1). Retrieved February 3, 2015, from http://www.who.int/mediacentre/factsheets/fs369/en/

Depression After A Cardiac Event or Diagnosis. (2014, June 16). Retrieved February 3, 2015, from http://www.heart.org/HEARTORG/Conditions/More/MyHeartandStrokeNews/Depression-and-Heart-Health_UCM_440444_Article.jsp

Depression and Stroke. (2011, January 1). Retrieved February 3, 2015, from http://www.nimh.nih.gov/health/publications/depression-and-stroke/index.shtml

Indiana University-Purdue University Indianapolis School of Science. (2014, February 3). Earlier depression treatment prevents heart attacks, strokes, study shows. ScienceDaily. Retrieved February 3, 2015 from www.sciencedaily.com/releases/2014/02/140203122827.htm

Nichols, N. (n.d.). What Causes Heart Disease? Retrieved February 3, 2015, from http://www.sparkpeople.com/resource/wellness_articles.asp?id=1609&page=3

Signs of Clinical Depression: Symptoms to Watch For. (2014, August 21). Retrieved February 3, 2015, from http://www.webmd.com/depression/guide/detecting-depression

Society of Nuclear Medicine. (2007, August 14). Brain Blood Flow Gives Clues To Treating Depression. ScienceDaily. Retrieved February 3, 2015 from www.sciencedaily.com/releases/2007/08/070808132027.htm