Tuesday, September 08, 2009

Will Treating Depression Treat Heart Disease?

That's the title on page 8, WSJ, thanks Shirley S. Wang.

I wondered when this would become news. It is true, or so it seems in my practice and clinical sense, that having a cardiac event puts a person at risk for depression. And being depressed puts us at risk for a cardiac event, given the genetics, probably, or self-abuse, like smoking and drinking, and let's not forget, stress.

It makes sense to treat it, obviously, because what could be more life-threatening than suffering times two from life-threatening illnesses? They both kill, depression and heart disease, or they can, without treatment.

Exercise, keep your cholesterol low, watch your blood pressure, take your heart medication if it's indicated, and talk to people about your fears, if you have heart disease. It has to be very scary, having this condition. And depressing when your activities are restricted, when you can't add a little salt.

And we know people who would die rather than give up that sirloin.

Anyway. WSJ tells us that patients who develop depression after heart attacks fare worse in the long term than those who don’t. A recent article in the Archives of General Psychiatry found that patients who develop severe depression post hospitalization for a cardiac event remain depressed for at least 6 months. They have double the risk of dying over the next seven years.

Thus cardiologists and behavioral scientists are wondering if treatment will improve prognoses, and if early screening is necessary. We already know that 6.7% of the general population gets depressed in any given year (National Institute of Mental Health).

Research is inconclusive regarding the effectiveness of treatment and screening, but I think most family physicians, probably internists, too, are sensitive to depression, ask about it as a matter of course. They know people kill themselves, and no one wants this on their conscience. Family physicians have always used us, the mental health professionals of the medical network, to treat this, depression. Tweak a bit with the meds and the psychotherapy, and voila, a better quality of life.

It's about time the cardiologists caught on. We've always been here.

therapydoc

14 comments:

balebusta said...

My FIL is a cardiologist and he has psychologists on staff at his practice...in my opinion this option is not available enough...actually, I think there should be a mental health clinician (not just a discharge planning social worker) on every hospital ward to provide brief treatment and referrals!

TechnoBabe said...

My hubby has bipolar disorder, has been hospitalized ten times over the years, and depression is part of the disorder. He is on lithium and seroquel this past year and has put on much weight. He is somewhat depressed again. Watching the cholesterol and weight and getting exercise is something I watch him struggle with and I am just happy he is here today and each day I have with him.

Glimmer said...

In the early 1980s, my father came out of coronary bypass surgery with flying colors. But with each passing day in the hospital got worse instead of better. We could not understand it, the doctor kept telling us his vital signs were excellent. We were in a panic, this man appeared to be on the verge of dying.

But his doctor insisted he leave the hospital. We argued. He asked us to trust him. He sent my father and mother to a hotel near the hospital because our hometown was two hours away. My father was assisted to the room where he stretched out on the bed, we thought never to get up again.

Within 30 minutes, he sat up and said, "Was that a restaurant I saw in the lobby? I believe I could have a bite to eat." She quickly grabbed her purse, took his arm and they went to the restaurant where he ordered a light meal, then returned to the room and napped. They stayed a few days and went home.

What this doctor surmised was that my father was suffering from depression and needed to be away from the hospital. And he was right, dramatically so.

Glimmer said...

In the early 1980s, my father came out of coronary bypass surgery with flying colors. But with each passing day in the hospital got worse instead of better. We could not understand it, the doctor kept telling us his vital signs were excellent. We were in a panic, this man appeared to be on the verge of dying.

But his doctor insisted he leave the hospital. We argued. He asked us to trust him. He sent my father and mother to a hotel near the hospital because our hometown was two hours away. My father was assisted to the room where he stretched out on the bed, we thought never to get up again.

Within 30 minutes, he sat up and said, "Was that a restaurant I saw in the lobby? I believe I could have a bite to eat." She quickly grabbed her purse, took his arm and they went to the restaurant where he ordered a light meal, then returned to the room and napped. They stayed a few days and went home.

What this doctor surmised was that my father was suffering from depression and needed to be away from the hospital. And he was right, dramatically so.

Ella said...

I'm in a big, center-based HMO. Was being treated for high cholesterol and anxiety in 2008.

After my heart attack in January 2009, I told multiple staff on the cardiology service that I was feeling anxious and depressed. No support group, no therapy group, nothing. Have you called behavioral health?, they ask. Nothing even at the heart institute of the hospital - they have valet parking but no support group.

I found WomenHeart- has survivor-led local groups and online support discussion lists. It has been fantastic. We understand each other, our New Normal, the challenge of recovery.

I did call behavioral health, finally, when my anxiety was overwhelming and I felt hopeless. Luckily the urgent intake nurse was just the right person. Luckily there was a cancellation and I was seen an hour later. Luckily this therapist did not ask me about my mother in the first visit and laughed at my gallows humor.

too much luck, not enough process.
Let me know if you want to hear from other women on this!

Glimmer said...

I wanted to clarify that my father's surgeon believed that his depression was situational, caused by the hospitalization. And once removed from that setting, he would bounce back. And that happened, dramatically. In case I wasn't clear.

I did not want to imply that the doctor was kicking him out because he wasn't getting better. He was one of the first surgeons to do these bypasses, Dr. Kirkland in Alabama, and had seen cases like that before.

therapydoc said...

Thanks BALEBUSTA and TECH.
GLIMMER, what a story. Perfect.
And ELLA, you bet I'd like to hear more from WomenHeart.

I understand that women with heart disease may be more vulnerable than men, which is news to me, because it isn't what you hear, or isn't what we used to hear. The reigning paradigm was that women are more robust than men, and outlive them. Now we hear that there's something about women which makes recovery from cardiac events more difficult.

And of course, the women get sicker quicker, referring to alcohol abuse and dependence, says it all.

tuesday@11 said...

My blood pressure has been high the past two years even though I am on meds to control it. I have been in therapy for the past two years for depression and anxiety. I began taking Prozac about three months ago and my depression has lifted and I no longer have constant thoughts of suicide. Just had my blood pressure checked and it is normal after all this time. Makes me wonder...

Nainja said...

My father had schizophrenia as a teenager for a short period of time and it reappeared after he had a heart operation in his late thirties. After that it never really went away again.
That's probably quite a drastic case and hopefully doesn't happen to often but it kind of shows how strongly such an operation can affect the mind.
I will also have a heart-operation somewhere in my thirties or fourties as I have the same genetic desease and it is part of it. I have to admit, I am a bit worried about the mental side-effects, although I don't believe or hope it will be as bad as schizophrenia.

Brate said...

According to the American Heart Association, heart disease is the nation's single leading cause of death for both men and women. At least 58.8 million people in this country suffer from some form of heart disease.
And on the whole, cardiovascular diseases (the combination of heart disease and stroke) kill some 950,000 Americans every year.
Still, there are many misconceptions about heart disease: "The biggest misconception is that heart disease only happens to the elderly," said Elizabeth Schilling, CRNP with the Center for Preventive Cardiology Program at the University of Maryland Medical Center.
In fact, according to the American Heart Association, almost 150,00 Americans killed by cardiovascular disease each year are under the age of 65. And one out of every 20 people below the age of 40 has heart disease.
So, it is now a wise decision to keep a constant monitoring of your health. Why to take a chance if we have the option. I was in the similar misconception that heart disease are far away waiting for me to get aged. But to my surprise, I was found to be having a calcium deposit in my coronary arteries. I need to have my advance diagnostic scans due reassure whether something really deadly is waiting for me. Though it was some dreadful going on in my life, but I never felt any kind of discomfort in Elitehealth.com advanced diagnostic facility. They were having some of the latest diagnostic equipments and non invasive techniques which made me feel safe.

Isle Dance said...

I can't help but think depression rates are higher, in general...or maybe that's just in my neck of the woods. It's a toughie, for sure.

nashbabe said...

Another interesting post!

I'm wondering just how "siloed" the various medical specialties are these days. This would be an example...does a cardiologist think of everything as a heart problem, and a psychiatrist think of everything as something that can be dealt with in a medication management session? Or etc.

For example, I would love to see more physicians up to date on sleep medicine. Sleep problems affect blood pressure and heart disease, depression, etc.

Just wondering about it in general. Your heart disease connection is a good example of the issue. Thx.

therapydoc said...

Thanks, Brate, for the stats, and for everyone's input here.

An ounce of prevention. . .So corny but true.

Marie Gronley said...

There is a very similar relationship between kidney disease and depression. Additionally those who have open heart surgery often suffer from depression after the surgery. I noticed in the article that the "jury is still out" with regards to these relationships being mere correlations or causative relationships? I believe that it cuts both ways; heart disease can bring on depression as well as depression bringing about heart disease. Recent studies have demonstrated that depression kills brain cells in the hippocampus region of the brain. SSRIs actually assist in the neurogenesis of taking stem cells and transforming them into brain cells thus replacing those that were killed by the depression. Depression can very well disrupt the glandular system and effect the hormones that protect the heart.