Cardiovascular Risks Higher in People with Depression, but Exercise Helps Both Conditions
The association between heart disease and depression is well established, and two large studies in the past year underscore just how serious the connection can be for people at risk of one or both of these chronic conditions.
A study of more than 145,000 men and women from 21 countries, published in JAMA: Psychiatry, found a 20 percent increase in cardiovascular events and death in people with four or more depressive symptoms. The risks were especially high in urban areas. The researchers suggest that symptoms of depression should be considered just as important as traditional cardiovascular risk factors, such as high blood pressure, high cholesterol, and smoking.
In a separate study of 4,000 adults, researchers found that people with symptoms of severe depression were 3.1 times more likely to have worse cardiovascular health than people without depression. Individuals with mild-to-moderate depression were 1.4 times more likely.
“People with depression may often engage in lifestyle habits that can contribute to poor cardiovascular health,” says David Mischoulon, MD, PHD, director of the Depression Clinical and Research Program at Massachusetts General Hospital. “For example, poor choices of food, or excessive food consumption. They may exercise less and generally be less physically active. They may also be prone to self-medicating with alcohol, tobacco, or other substances. And individuals with depression often sleep poorly. All of these factors are known contributors to poor cardiovascular health.”
Two-Way Street
But the connection between poor cardiovascular health and depression goes both ways. While people with depression may adopt a lifestyle that contributes to heart disease risk, a diagnosis of heart disease also increases the odds of developing depression. It’s not unusual for an individual who survives a heart attack or stroke or is diagnosed with a chronic condition such as heart disease or cancer to show depression symptoms such as hopelessness, sadness, anxiety, and apathy.
“Depression after a heart attack or stroke is common, and may have different underlying factors,” Dr. Mischoulon says. “Any type of insult to the brain, as when a person experiences a stroke, can cause brain damage that may present as depression. During a severe heart attack, there may also be less oxygen going to the brain, which could contribute to depression later on. Also important is the psychological impact of having a stroke or heart attack. Often, these happen unexpectedly in people who had no prior history or symptoms, and this represents a huge shock to the person, perhaps confronting them with their own mortality for the first time.”
For these reasons it’s important that people who experience a major health scare or receive a jarring medical diagnosis be aware of signs that depression may be taking hold. Family members and friends of these individuals should also be on the lookout for symptoms of depression or anxiety and be willing to gently discuss them when they appear.
Complicating Factors
Adding to this difficult relationship is the presence of other factors that can worsen heart disease and/or depression. Dr. Mischoulon notes that if someone with depression also has one or more coexisting illnesses, poor management of those concurrent conditions may also contribute to an added stress on the heart. “Another consideration is stress itself,” he says. “Stress may be a contributor to both depression and heart disease, and may also be a consequence of depression, in the sense that people who are depressed may have more difficulty dealing with the usual stresses in their lives. This increase in stress, and difficulties coping with it, may have further negative effects on the heart.”
He adds that people who have heart attacks or strokes may have complications from the illness, including physical or mental limitations, such as memory problems, that may prevent them from fully engaging in their usual activities. “This in turn can contribute to depression from the experienced loss of quality of life,” Dr. Mischoulon says.
Get Help
Treating depression is very important, because treatment can reverse the symptoms and behavior patterns that can contribute to heart problems, Dr. Mischoulon explains. “Treatment strategies can include prescribing antidepressant medications that may alleviate depression,” he adds. “However, care needs to be taken with antidepressants because they may in turn cause certain side effects, such as weight gain, that can in themselves have negative cardiovascular effects.”
Certain types of psychotherapies, such as cognitive behavioral therapy, can help a person to develop better coping skills and healthier ways of managing stress, as well as promote more positive health behaviors, such as being more active and eating more healthfully.
Taking the initiative to begin therapy and stick with it can be a tall order for someone with depression. But with the support of family and friends, it can be a life-changing and lifesaving decision. The same is true for a healthy lifestyle, featuring regular exercise. It can be a challenge to get up and get moving every day, but the benefits to mood and heart health can’t be understated.
“Studies have shown that exercise indeed has beneficial effects on depression,” Dr. Mischoulon says. “Benefits can include improved mood as well as better cardiovascular health. However, because of depression-related fatigue and lack of interest, it can be difficult to get a depressed patient motivated enough to engage in a rigorous exercise program… I encourage my patients to try to be more physically active, and by that I don’t necessarily mean engaging in rigorous exercise. Even walking half an hour to an hour every day or a few times a week can be beneficial. They do not necessarily have to go to a gym or engage in hardcore weightlifting or running to get benefit, though these activities may be introduced over time as the patient gets more accustomed to regular physical activity.”
Takeaway
If you have cardiovascular disease, it is very important that you remain engaged and proactive in your medical care, Dr. Mischoulon advises. “Work closely with your primary care physician and/or cardiologist, and try to follow the recommendations in terms of staying on your medications and following a healthier lifestyle. This will allow you to remain more engaged in life, and hence less likely to develop depression.”
The role of family and friends is also very important, he adds. A supportive environment can do wonders for a person’s physical and mental health. There is evidence that patients who are married or partnered tend to have better quality of life and longevity. “If you have a spouse or loved one with heart disease, you can do a great deal for their health by being supportive of them and encouraging them to be engaged in life and to remain active, as well as following instructions from their health-care providers,” Dr. Mischoulon says.
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