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Published on: December 2, 2015
Depression and ischemic heart disease
C M O'connor1, P A Gurbel, V L Serebruany
1Duke University Medical Center, Durham, NC, USA.
Insights
Major depression significantly increases the risk of ischemic heart disease (IHD) and mortality. Effective antidepressant treatments can improve recovery for patients with IHD and depression.
Area of Science:
- Cardiology
- Psychiatry
- Psychophysiology
Background:
- Major depression frequently co-occurs with ischemic heart disease (IHD).
- Psychological stress and depression are increasingly recognized as risk factors for cardiovascular disease.
- Individuals experiencing mental stress face double the risk of myocardial ischemia.
Purpose of the Study:
- To explore the link between depression and cardiovascular morbidity and mortality in patients with IHD.
- To highlight the importance of recognizing and treating depression in IHD patients.
Main Methods:
- Review of clinical studies and evidence linking psychological stress, depression, and cardiovascular events.
- Analysis of mortality rates in post-myocardial infarction patients with and without depression.
Main Results:
- Depression is associated with a substantially higher risk of cardiovascular morbidity and mortality.
- Patients with post-myocardial infarction depression exhibit increased mortality rates compared to controls.
- Platelet activation may be a contributing factor to the increased cardiovascular risk in depressed individuals.
Conclusions:
- A psychophysiological mechanism likely underlies the increased vulnerability of depressed patients to IHD.
- Physicians should actively screen for depression in IHD patients, especially those recovering from acute ischemic events.
- Depression can complicate IHD recovery but is often treatable with antidepressant medications.
Abstract:
Major depression is a common comorbidity associated with ischemic heart disease (IHD). There is growing evidence that psychological stress in general and depression in particular predispose to cardiovascular disease. Persons who have mental stress during daily life are at twice the risk of myocardial ischemia, and patients with post-myocardial infarction depression have higher mortality rates than nondepressed controls. These data suggest a psychophysiologic mechanism underlying the vulnerability of depressed patients to IHD. Clinical studies have demonstrated that depression is associated with a much higher risk of both cardiovascular morbidity and mortality, which could be caused by platelet activation. Physicians should maintain a heightened level of clinical suspicion for depression and depressive disorders in persons with IHD, particularly those individuals who are recovering from an acute ischemic event, such as myocardial infarction. Furthermore, depression may complicate the recovery of IHD, but in most cases depression can be effectively treated with antidepressant agents.
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