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Doctor Debug was published in the Seattle magazine Tekbug

Now published in Montana's Natural Life News and Directory
Published in September-October 2005 Edition

Depression and Your Heart

    Dear Dr. Debug:

      I am 58, and I have recently learned one of the most difficult lessons of my life -- depression can kill you in other ways than being suicidal. It is bad for your heart. I should know. I have had two heart attacks. I refused the opportunity to take an antidepressant after the first one. I am now taking Celexa. Could you let your readers know more about this problem? Thanks. -- Signed: Concerned About Others.

    Dear Concerned:

      Thank you for writing! This is an important concern. Although a few older studies indicated a link between post-heart attack depression and increased death rates, those 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® (fluoxitine), Paxil® (paroxetine), Zoloft® (sertraline), Celexa® (citalopram), and Lexapro® (escitalopram). The older antidepressants, such as Elavil® (amitriptyline) and Pamelor® (nortriptyline), are known to have potentially 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 the 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. This is a good thing because platelet aggregation and other platelet activity play key roles in the onset of heart attacks. Inhibiting such platelet processes can assist in keeping damaged arteries open and the blood flowing to heart muscle.

      It seems common sense to me that moderate depression is a risk factor for all kinds of health problems. It has been shown that people experiencing moderate depression clearly do not take care of themselves as well as people who have no symptoms of depression. Studies have shown people with moderate depression tend to make more 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 irrelevant. 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. Debug.

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