Mind Matters - May 2007
Written by Ron Sterling, M.D. and Published in Northwest Prime Time Magazine

How Does Depression Kill?
by Ron Sterling, M.D. -- May 2007

    Dear Dr. Ron:

      I read your article last month called Depression Kills. Can you tell me how depression shortens lives or contributes to increased illnesses? Signed: Wanting More Answers.

    Dear Wanting:

      Thank you for writing! This is a very complex question for this short column, but I think I can point out a few important studies.

      The problem with the term depression is that it can mean anything from a "bad hair day" to a serious disorder. I use the term "clinical depression." Clinical depression is a short way of saying "Major Depressive Disorder" (MDD) which is the official diagnostic term. The criteria for the diagnosis of MDD are too long for this short column. Please visit All About Depression web page to get more information about depression. Citations for this article can be found at the bottom of this page.

      The studies that are pertinent to your question can be grouped into four categories (1) depression and suicide; (2) depression and poor outcomes related to heart attacks; (3) depression and the immune system; and, (4) depression and risky lifestyle "choices."

      Suicidal behavior is related to many emotional situations (terminal illness, bereavement, failures), drug and alcohol use, and to mental conditions, including depression, bipolar disorder, and schizophrenia. Best estimates are that 60% of suicides occur with people who are dealing with a clinical depression. Clinical depression is clearly a risk factor for suicide and studies have shown that more severely depressed people are at more of a risk.

      Twenty percent of patients hospitalized for myocardial infarctions had major depression. Most patients who were depressed during hospitalization continued depressed (they were untreated). Patients with co-existing myocardial infarction and depression had poor quality of life in the year after hospitalization and had an increased risk of death. A 2003 report that summarized a 29-month study called Enhancing Recovery in Coronary Heart Disease Patients found that after adjustment for baseline depression scores and cardiac risk factors, use of SSRIs was associated with a 43% lower risk of death, nonfatal myocardial infarction, and all-cause mortality. SSRIs are Prozac-like antidepressants that have effects on serotonin receptors and serotonin levels in the body.

      Immune system studies are mostly inconclusive as to whether the changes that have been noted in depressed people have significant impacts on health or life span. The relationship between depressive symptoms and changes in inflammatory response after an influenza virus vaccination in 119 older adults (average age of 71) was reported in 2003. The study showed that even a small number of depressive symptoms can produce amplified and prolonged inflammatory responses in older adults.

      Many lifestyle studies have attempted to figure out what came first, the depression or the risky lifestyle choice. Studies have looked at how clinical depression affects behaviors such as non-compliance with medications and treatment for life-threatening illnesses, over-eating or under-eating, smoking cigarettes, abnormally high use of alcohol and illicit drugs, and risky sexual behavior. Among other things, there is a high correlation between depression and smoking.

      Compared with non-depressed patients, the odds are three times greater that depressed patients will be non-compliant with medical treatment recommendations that could shorten their lives. Non-compliant behavior included not taking medication correctly, forgetting or refusing to follow a diet, not engaging in prescribed exercise, canceling or not attending appointments, and persisting in lifestyles that endangered health.

      What does all this mean? We don't know for sure yet, but there are strong indications that low serotonin levels have wider effects in the body than just on the brain. Serotonin appears to play a role in platelet aggregation, which, in turn, plays a role in heart attacks. Serotonin is passed between key cells in the immune system. The serotonin type 4 (5-HT4) receptor has been associated with functions of the gastrointestinal tract.

      I think the message is "never underestimate the harmful power of clinical depression and be diligent in treating it or helping someone you know get proper treatment." I hope this helps. -- Best wishes, Dr. Ron.

    Links to Articles and Abstracts

    Listed below are links to online articles and abstracts for more information about the different ways that depression kills.

        Thank You for Stopping By!

      Have a great day!

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