Will Treating Depression Treat Heart Disease?

[question everything]

SEPTEMBER 8, 2009

Will Treating Depression Treat Heart Disease?

By SHIRLEY S. WANG
WSJ

Patients who develop depression after heart attacks fare worse in the long term than those who don't. But will treating their depression prevent further heart problems and safe lives? That question plagues medical experts and is a source of fresh contention among cardiologists and behavioral scientists looking for effective strategies to help patients suffering from both conditions.

Depressed people are more likely to have heart attacks, and 15% to 20% of those who have had heart attacks get depressed, according to the American Heart Association. In contrast, 6.7% of adults in the overall U.S. population will be become depressed any given year, according to the National Institute of Mental Health. Moreover, depressed heart patients have a greater chance of dying and a worse quality of life compared to those who aren't depressed. A study published Monday in the Archives of General Psychiatry found that patients who developed severe depression after being hospitalized for a cardiac event, and remain depressed for at least six months, had more than double the risk of dying over the next seven years.

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Remedies for depression in the general population include antidepressant medications, such as Prozac, that have transformed treatment of the condition in the past two decades, and psychotherapy. But there is surprisingly little research examining whether these approaches help prevent deaths or heart attacks among heart patients who also suffer from depression. In a move that continues to spur debate, the American Heart Association came out with recommendations last year stating that all heart-disease patients should be screened for depression, and those with symptoms should be treated. The guidance, endorsed by the American Psychiatric Association, was issued even though both organizations acknowledged a lack of evidence that such screening improves outcomes in patients with heart disease. Just last week, the Journal of the American College of Cardiology published a pair of opposing editorials on the topic.

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The few studies to look at the impact of treating depression in heart patients had results that aren't impressive when it comes to preventing further cardiac problems. One even cautions that treating newly depressed patients in the aftermath of a heart attack could be harmful. The largest trial to address the issue, published in 2003, assigned 2,481 heart patients to six months of either psychotherapy or continuing to receive care from a cardiologist or primary care doctor and followed them for an average of 2½ years. It was up to the doctors in either group to decide whether to prescribe antidepressants. Overall, those in the psychotherapy group reported improved symptoms and less social isolation, an important factor in long-term prognosis of heart patients. But rates of death and subsequent heart attacks were about the same in each group.

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So what should patients do? For one thing, doctors say that getting effective treatment for depression is likely to improve the quality of life for heart patients, whatever the impact on their cardiac condition. In addition, Dr. Davidson says, any patients who ask for help with depression should be referred for treatment. Ample evidence indicates depressed patients who take the initiative in seeking care do well on either antidepressants or psychotherapy.

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Printed in The Wall Street Journal, page B8

http://online.wsj.com/article/SB20001424052970204584404574392802398250882.html (subscription)

[Fire_Medic_Dave]

1. Interesting. Huge number of variables in play. Difficult to study.

For instance, it is quite common for people with depression to have sleep disturbances. Recent studies have shown that getting less than 6.5 hours of quality sleep greatly increases stress levels in the body and dramatically increases the risk of heart and lung disease. Of course diet and hormone imbalances could be a factor in both depression and heart disease. Hope they come up with some good research.