Saturday, December 22, 2007

Link between depression and heart disease needs our attention

Photo by Adoodi (Flickr)

Poorer outcome for depressed patients

This is the text of my That's Men for You column in The Irish Times on Tuesday, 18th December:

The link between depression and heart disease is not often written about, perhaps out of fear of causing distress to people with one or the other of these conditions or with both. But to remain silent about the link is to deprive people of information that could save their lives.

The latest research, from Columbia University’s College of Physicians and Surgeons, confirms earlier findings that people who are depressed following a heart attack are significantly more likely to die during a follow-up period than heart patients who are not depressed. This outcome has been found in follow-up periods ranging from six months to more than six years in different studies.

Other research suggests that people who are depressed are more likely to suffer heart illness in the fist place than those who are not depressed.

Quite how it works is not clear. One theory is that in depression the brain’s regulation of the production of sticky platelets in the blood is impaired, that this brings about an increase in the production of the platelets and that this in turn can lead to an event such as a heart attack.

Effect on behaviour

However, It is also possible that the poorer outcome for depressed people following a heart attack is related to the way depression affects their behaviour. For instance, people who are depressed can find it difficult to motivate themselves to exercise, to take their medication or to modify their diet. If they are smokers, then giving up smoking will be far more difficult when they are depressed. All of these things, let’s face it, are hard enough to do when you’re not depressed.

In these instances, one can see how easily depression can leave a person more vulnerable to future heart problems.

What matters in all of this is to understand that depression is a real issue that needs to be taken very seriously after a person has a heart attack or develops another heart condition.

Depression not surprising
We need to remember that when you have a heart attack your whole view of yourself, your health and your life changes. So it’s not surprising that for some people this leads to depression.

One can also see how a person who led a very stressful life before a heart attack could become depressed afterwards at not being able to give the same energy to the issues about which he or she was stressed. If they have had to give up the work they used to do, then the emotional impact can be very, very strong.

It is important, if somebody close to you has heart disease, to recognise that depression may cause them to fail to exercise or to fail to comply with their medication or dietary requirements.

In such a case the issue of depression should be raised with the GP who may refer the person to a counsellor. If you prefer to contact a counsellor directly you can get the name and telephone number of an accredited counsellor from the Irish Association for Counselling and Psychotherapy at 01-2723427.

Exercise and mood
It is also helpful to encourage the person to carry out faithfully the exercise regime prescribed by the hospital or by the GP. Aside from the physical health benefits, exercise is known to improve the mood and is an important ally in the fight against depression.

I have directed this advice to people close to the person with depression because it can be hard for the person who is depressed to motivate himself or herself to do these things.

But if you have had a cardiac problem and you are not depressed, follow that exercise regime that the doctor advised: it will keep you in good shape psychologically as well as physically.

I’ve used the word ‘link’ in talking about depression and heart disease throughout this article because what we seem to know is that there is a very definite link between the two but what we don’t know is exactly how that link works.

There is, nevertheless, a link which is all the more reason for doing something about depression instead of letting it drag on and on - especially the wake of heart disease.

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