The link between depression and heart disease isn't just about behavioral issues. Researchers are finding the heart disease and depression connection is more complicated.
A link between depression and heart disease was long thought to be strictly behavioral, according to the American Heart Association (AHA). For example, a person suffering from depression might eat or drink too much, not get enough sleep, and skip exercise — all behaviors that can up heart disease risk.
However, in recent years researchers have found the head-heart health connection is more complicated. In fact, preventing and treating mental health problems might literally save you from a broken heart.
A study based on data from over 20,000 participants in the Canadian Community Health Survey revealed that people who had suffered a mental health disorder at any point in their life were twice as likely to have had heart disease or a stroke. Somehow, mental health woes seemed to harm circulatory health, but how?
Scientist Katie Goldie of the Center for Addiction and Mental Health in Toronto, who presented the research last fall at the Canadian Cardiovascular Congress, said behavior factors, such as more smoking and drinking, eating less nutritious diets, and lower physical inactivity among those with mental health problems played a role. But there were other factors, too.
People suffering from depression, anxiety, bipolar disorder, and other mental health issues don’t always communicate their health needs and concerns or even seek needed healthcare because of their mental state, Goldie pointed out. “A separation between primary and mental health services can also challenge these patients’ care. We need improved integration and collaboration,” she said.
The Canadian researchers also looked at a range of psychiatric medications (antipsychotics, antidepressants, benzodiazepines for anxiety, and mood-stabilizers) and sounded a warning that taking some of these drugs appeared to double the risk of heart disease and tripled the risk of stroke. The explanation, Goldie explained, was likely that psychiatric meds sometimes cause weight gain and also impair the breakdown of fats and glucose. These side effects raise the risk for high cholesterol and diabetes which, in turn, ups the chance of developing cardiovascular disease.
However, that doesn’t mean people with mental health problems should fear taking needed medication. In fact, Canada’s Heart and Stroke Foundation (HSF) psychiatrist Brian Baker, who specializes in treating people with heart disease, emphasized that a safe approach is having a cardiovascular risk assessment before and after starting drug therapy for a mental health condition.
“It is important that people talk to their doctors, continue to take their prescribed medications and follow healthy behaviors,” Baker said. “That means eating a healthy diet, being physically active, being smoke-free, managing stress and limiting alcohol consumption. Making positive health behavior changes is important to our physical health and to mental health, too.”
There’s evidence that certain drugs used to treat mental health conditions may actually benefit the heart. Duke University researchers have found that escitalopram (marketed as Lexapro), a selective serotonin reuptake inhibitor used to treat depression and anxiety, can improve a stress-related heart condition.
A study published in the Journal of the American Medical Association concluded that people with stable heart disease who took the antidepressant were more than two-and-a-half times less likely to have mental stress-induced myocardial ischemia, a heart condition that blocks the heart from receiving adequate blood flow, than patients not taking the drug.
"Mental stress-induced myocardial ischemia is a serious condition, as patients with the condition tend to have worse heart problems compared to patients without it," said Wei Jiang, associate professor of psychiatry, behavioral sciences and internal medicine at Duke. "This study showed for the first time that it is treatable with an emotion-modulating medication."
Another study found that screening for and treating depression could significantly reduce the risk of heart disease. After analyzing the health records of more than 26,000 patients, researchers at the Intermountain Medical Center Heart Institute in Salt Lake City, Utah, concluded that patients with moderate-to-severe depression who took antidepressants had a lower risk of death, coronary artery disease, and stroke than patients with moderate-to-severe depression who did not take antidepressants.
In fact, among people with moderate-to-severe depression, taking antidepressants was more effective for lowering the risk of heart disease that taking statins, the widely prescribed cholesterol lowering drugs.
“Antidepressants might have relevant physiological benefits, but I also think that improving a person’s mood can contribute to a cascade of behavioral changes that improve cardiovascular health,” said Intermountain Medical Center Heart Institute epidemiologist Heidi May, PhD, the study’s lead author. “Focus is usually placed more on traditional cardiovascular risk factors and unfortunately, depression is often overlooked. This study adds to the evidence that, when used properly, antidepressants can improve cardiovascular outcomes among those with depressive symptoms.”
If you have a family or personal history of heart disease or mental health problems, it makes sense to learn about the links between body and mind and to be proactive in seeking appropriate care. The National Institute of Mental Health provides information on heart disease and depression and the AHA offers heart-healthy advice on lowering stress.
March 03, 2020
Christopher Nystuen, MD, MBA