Depression and Heart Disease

Heart disease, also called cardiovascular disease, is the leading cause of death for both men and women in the United States.[1] While heart disease may be a leading cause of death, depression was named the leading cause of disability worldwide - with more than 300 million people living with depression across the globe. [2] Depression has been suggested to be recognized as a risk factor for heart disease just like diabetes, high blood pressure and smoking.

It is important to be aware of the head-heart connection. Newer research shows that biological and chemical factors that trigger mental health conditions like depression, can also influence your risk of heart disease.

How many people are affected by heart disease and depression?

• Up to 40% of heart disease patients meet criteria for major depressive disorder [3]
• 20-30% may exhibit minor depression or elevated depressive symptoms [4]

How are heart disease and mental health related?

• Tobacco Use: A 2016 survey found that 32% of adults with a mental illness reported current use of tobacco compared to 23% of adults with no mental illness. Tobacco use is a major risk factor for developing heart disease. [3] 
• Stress: Stress hormones like cortisol increase the risk of heart problems and are thought to be related to a number of mental health conditions like anxiety and depression. Unmanaged stress can lead to high blood pressure, arterial damage, irregular heart rhythms and a weakened immune system.
• People with depression and no history of heart disease develop heart disease at higher rate than the general population. For example, someone with depression may be less likely to have healthy eating and exercise habits and more likely to abuse alcohol – all of which put you at greater risk for heart disease. [4]
• Those who already have heart disease, especially those who have suffered a heart attack, are at greater risk of being diagnosed with depression. For example, someone with no history of depression might start to show symptoms after the trauma of a heart attack while dealing with the pressures of recovery and fear of it happening again.  

When a person has both heart disease and depression, the long-term outlook for both conditions can worsen so it is important to continue your mental health care during and after cardiac recovery. 

Depression can make recovering from a heart attack harder by intensifying pain, worsening tiredness or causing a person to further isolate themselves. [5] One landmark study found that people with continued depressive symptoms within 6 months after a heart attack had a 14% higher chance of dying than those without depression.[3]

Symptoms can overlap.

Depression and heart disease have overlapping symptoms like fatigue, low energy, and difficulty sleeping. It is important to be attentive to your body and recognize what is abnormal for you. 

Not enough heart attack survivors are told about how common post-heart attack depression is, and not enough people with depression are told by their mental health provider about how their condition can affect their heart health.

In fact, the American Heart Association and the American Psychological Association recommend routine screening for depression for those with heart problems as more and more evidence is showing depression to be a risk factor for heart disease.

Effective treatment could help the heart and the mind.

Healthy lifestyle practices like a balanced diet, exercise, and stress management can help prevent or reduce cardiac and mental health symptoms.

Regular exercise can help reduce depression by releasing feel good-endorphins. It also makes your heart stronger and has positive effects on blood pressure. Managing stress can be a good idea for your overall health and new research suggests that psychosocial therapy can improve quality of life, blood pressure and satisfaction with care. [6] 

While there is a lot of overlap in the risk factors for developing heart disease and mental health problems, healthy lifestyle changes can benefit both conditions.

If you are currently being treated for depression, talk to your doctor about medications you might be taking and the risk of heart disease. If you have heart disease and you think you might be showing signs of depression or another mental health condition, take a free anonymous screen and talk to your doctor about a referral to a mental health provider.

Sources

CDC, NCHS. Underlying Cause of Death 1999-2013 on CDC WONDER Online Database, released 2015. Data are from the Multiple Cause of Death Files, 1999-2013, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed March 4, 2019.

Friedrich, M. (2017, April 18). Depression Leading Cause of Disability Globally. Retrieved from https://jamanetwork.com/journals/jama/article-abstract/2618635

Substance Abuse and Mental Health Services Administration. Results from the 2016 National Survey on Drug Use and Health: Detailed Tables. Cdc-pdf[PDF–35 MB]External Rockville, MD: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality, 2017 [accessed 2018 Jun 18].

Frasure-Smith, N., Lespérance, F., & Talajic, M. (1993, October 20). Depression following myocardial infarction. Impact on 6-month survival. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/8411525

Dhar, A. K., & Barton, D. A. (2016, March 21). Depression and the Link with Cardiovascular Disease. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4800172/

Wang, J. T., Hoffman, B., & Blumenthal, J. A. (2011, January). Management of depression in patients with coronary heart disease: Association, mechanisms, and treatment implications for depressed cardiac patients. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2997888/

Day, J. A. (2016, April 14). Depression and Heart Disease. Retrieved from https://www.hopkinsmedicine.org/heart_vascular_institute/clinical_services/centers_excellence/womens...

Rees, K., Bennett, P., West, R., Davey, S. G., & Ebrahim, S. (2004). Psychological interventions for coronary heart disease. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4170898/  

Ahmed, A. A., Patel, K., Nyaku, M. A., Kheirbek, R. E., Bittner, V., Fonarow, G. C., . . . Ahmed, A. (2015, July). Risk of Heart Failure and Death After Prolonged Smoking Cessation: Role of Amount and Duration of Prior Smoking. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5499230/