Anyone who has ever suffered from a heavy heart knows too well the physical feeling of real hurt but up until now depression has always been held to be all in the mind. Not any more. New evidence proves that the heart does go through pain and injury. So much so, in fact, that the risk of heart disease goes sky-high.
For those with pre-existing heart conditions, the addition of depression means that the likelihood of dying within six months goes up four-times.
Depression is such a big risk factor for heart disease, that Professor Gavin Lambert puts it right up there with smoking. Lambert, who works at the Baker IDI Heart and Diabetes institute, says depression both increases the chance of contracting and exacerbates existing heart problems.
Depression has an impact on the heart, not just in a metaphorical or emotional sense. During a bout of bad depression, the body releases more of the stress hormone, noradrenaline. This puts the body in a permanent state of high anxiety, the “fight or flight” response. If this goes on for too long, the noradrenaline starts to harm the blood vessels. Just like smoking, it can cause arteries to narrow and mean they can get blocked more easily. Blood flow is restricted and this raises blood pressure. Other changes cause plaque to build up on the walls of the blood vessels, and in addition to all of this, inflammation can be triggered. Inflammation is notorious in leading to formation of blood clots.
If a person is depressed, along with all this going in their heart, they are more likely to be experiencing other lifestyle changes that may lead to poor heart health. Constant low mood can form dependencies on cigarettes and alcohol, eating a proper diet and getting enough sleep and exercise go out of the window.
Lambert has launched a study to investigate further into the links between depression and heart disease. He aims to determine if use of antidepressants, serotonin re-uptake inhibitors, lowers the risk. He is also keen to find a genetic connection. One in three depressed patients have an enhanced “fight or flight” response, but no pre-existing heart disease. This heightened and overactive output of noradrenaline is thought to come from a gene.
Anther possibility is that the inflammatory chemicals that lead to heart disease could also be causing brain changes, hence the link between the hurting heart and the depressed mind. Physiologically, a circulation struggling to supply blood oxygen and nutrients around the body is also going to be struggling to get those things to the brain.
The Heart Foundation has had depression on its list of risk factors for heart disease for ten years, but many medical professionals still do not recognize the seriousness of it, not the fact, that the more chronic the depression, the worse the risk is. James Tatoulis, a professor and the Chief Medical Officer to the Heart Foundation, calls for more doctors to screen heart patients for depression.
A new questionnaire launched at the World Congress of Cardiology in Melbourne aims to challenge this attitude. Heart attacks patients should routinely be asked about their mental well-being as well as their other lifestyle factors, if the questionnaire is widely adopted.
Depression being as high a risk factor for heart disease as smoking, raised cholesterol and high blood pressure is a fact that deserves to be much better known and understood. Not only is the risk factor so significant, but presence of depression adversely affects recovery in those who have had heart attacks.
Lambert’s work follows research by Dr Angelos Halaris, of Loyola University, who last year formally proposed a new specialty, named “psychocardiology” to concentrate on the link between depression and cardiac disease. Like Lambert, Halaris wants to raise awareness, both in the general public and in the world of physicians, about the very real correlation between depression and a hurting heart.
By Kate Henderson