A sad heart could be a sick heart too

Could a sad heart lead to an unhealthy heart? That seems to be what is suggested from a study published in the Journal of the American Medical Association (JAMA) led by Dr. Mary Whooley, a physician at the University of California, San Francisco (see link to abstract at JAMA here). A recent article published by her discusses how major depression is a risk factor for the development of heart disease in healthy patients and for poor outcomes in patients with known heart disease.

In Dr. Whooley’s study she looked at over 7500 elderly women and tracked them over 7 years. She tracked them on a sort of depression scale to see how many symptoms and signs of depression they had. What she discovered was that 7% of women with no signs of depression passed away over the period of her study while 17% of women with three to five signs of depression passed away. Most alarming of all, 24% of the patients with six or more signs of depression passed away. In short, the more depressed her study subjects were the more likely they were to die of heart disease. Dr. Whooley was able to make the link between heart disease and depression by correlating her data with that of many other studies, most notably:

• A study in Denmark of 700 men and women that was followed for 27 years showed that those with depression had a substantially greater risk of hear attack and death
• Another study of 8000 men and women that showed an increase risk of coronary heart disease in depression patients
• a study of patients who were healthy and free of heart disease but for whom the risk of developing heart disease and dying from it was actually caused by depression.

But what might be the connection between depression and heart disease? Is it simply being blue clogs your heart or is depression a trigger for biological changes that bring on the disease? In an article by Dr. Tedd Mitchell for USA Weekend (July 28-30, 2006 edition) and an in an interview for National Public Radio (NPR) of Dr. Sydney Spiesel, Yale Medical School professor and Slate medical columnist, they both note the following possible biological connection between heart disease and a sad heart:

• Depressed people have a greater resting heart rate potentially leading to heart stress or abnormal heartbeats
• Hormones that control blood pressure and heart rate are higher in depressed patients
• Blood platelets are more activated in depressed patients that could lead to a greater incidence of blood clots and heart attack or stroke
• Behavioral issues come to play too, depressed patients tend to generally smoke more, exercise less, eat more poorly and are less compliant to taking medications that you’ve been prescribed to help keep heart disease from advancing.

So since being depressed is one cause of heart disease, what to do if your so blue? There are a number of potential weapons at your disposal that will help your mood and your heart too. Anti-depressants are one way to go. Dr. Whooley notes in her study that treatment with anti-depressants with selective serotonin reuptake inhibitors is a generally safe approach to alleviate depression. But some studies have shown that exercise is actually more effective.

In a study done in the British Journal of Sports Medicine (April 2001;35:114-117) found that just 30 minutes of walking daily improved depressed patients symptoms faster than medication. And in another study, published in Psychosomatic Medicine (September/October 2000;62:633-638) the researchers found when comparing treating depression with either 45 minutes of exercise three times per week or Zoloft, a popular anti-depressant that is a selective seratonin reuptake inhibitor, the exercise group were more likely to be partially or fully recovered from depression than those in the medication group.

So a sad heart can indeed be a sick heart too and treating it best may include anti-depressant medication or perhaps plain old exercise to make your heart happy and healthier too. My bet is on the exercise, it’s easy and cheap and has many side benefits in helping you physically and mentally, a combination that is time efficient and can’t be beat.

(silver heart photo from Lonely Angel Photos, used under Creative Commons license)