Written by Ron Sterling, M.D. and Published in Northwest Prime Time Magazine
by Ron Sterling, M.D. -- August 2005
Thank you for writing! This is an important concern. Although there are a few older studies that indicated a link between post-heart attack depression and increased death rates, the findings were not widely publicized. Even at that American Heart Association Web site, you will not find depression listed as a risk factor for coronary heart disease. They have chosen to take what could be viewed as an overly-cautious approach to the discussion of mental illness factors involved in cardiovascular disease. It is unfortunate, but it may be an indication of how stigma related to mental illness still negatively influences our ability to properly treat the whole person.
The latest study from Stanford University School of Medicine received wide publicity in early July of this year after it was published in the Archives of General Psychiatry. That study indicated that antidepressants lessened the risk of a second heart attack and cardiac death. That study is the strongest evidence to date showing that certain antidepressants are safe and have clear benefits. When I say "certain antidepressants," I am referring to the selective serotonin reuptake inhibitors (SSRIs), which include Prozac, Paxil, Zoloft, Celexa, and Lexapro. The older antidepressants, such as Elavil (amitriptyline) and Pamelor (nortriptyline), are known to have adverse cardiac effects.
The July 2005, Stanford study indicated that those taking SSRIs after their first heart attack had a 43% lower risk of death or a second heart attack. Patients were followed for an average of 29 months. Although it is clear that SSRIs had a profoundly positive effect on subsequent complications of first heart attacks in depressed patients, the mechanism of action is not exactly clear. In fact, it may be true that even non-depressed, first heart attack patients should receive SSRIs. A few studies have indicated that SSRIs can inhibit blood clotting cells called platelets. Platelet aggregation and other platelet activity play key roles in the onset of heart attacks.
It seems common sense to me that moderate depression is a risk factor for all kinds of health problems. Depressed people clearly do not take care of themselves as well as non-depressed people. Studies have shown that depressed people tend to make unhealthy lifestyle choices and engage in more risky behavior including bad diets, and tobacco, alcohol and illegal drug use. In addition, they often do not follow-through with taking proper medications in a consistent manner for such illnesses as high blood pressure and diabetes.
An Ohio State University study analyzed data from 5,007 women and 2,886 men who took part in the first National Health and Nutrition Examination Survey. Researchers only looked at individuals with no previous history of coronary heart disease. Study participants were assessed for depression using a standard depression scale. They were followed over a 10-year period -- between 1982 and 1992. Depressed women were more likely than non-depressed women to develop heart disease. Depressed men were not only more likely to develop heart disease, but they were more likely to die from it.
To me, the question "what came first, the depression or the heart attack?" is mostly unimportant. Depression, especially if it is more than mild, and especially if it includes such pessimism about life that it produces unhealthy behavior, needs to be treated, whether it potentially can lead to a heart attack or not. -- Best wishes, Dr. Ron.
Ron Sterling, M.D. is a 64 year-old General and Geriatric Psychiatrist with a private practice in Seattle. He invites you to e-mail him at with any questions about mental wellness or emotional, relationship, or aging concerns. He is the only person who reads e-mail sent to Dr. Ron. Please be assured that your questions and identities are completely confidential and protected. For more information about Dr. Ron and for resources related to senior mental health, please go to SeniorMentalHealth.org. The content offered through Mind Matters is for information only and is not intended for medical, psychiatric, or psychological diagnosis or treatment. Never disregard professional advice or delay seeking it because of something you have read in this column. Read our Disclaimer. If you wish to understand more about Dr. Sterling's potential biases in health care advocacy, please check his Conflicts of Interest Disclosure Statement
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RON STERLING, M.D.
General Psychiatry with Specialization in Adult Attention Deficit Disorder
Updated October 7, 2007
Copyright 2000-2007. Ron Sterling, M.D. All Rights Reserved.
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