Friday, February 05, 2010

Depression: bad for you and your heart

Depression: Bad for you and your heart

 By Michael J. Salamon

Depression can be a debilitating disorder for many people and it comes in several different forms, some more severe than others.

To simplify the categories of this mood disorder, depression can be understood according to the following easy paradigm. Situational depression is a change in mood that is often referred to as the blues that comes and goes; it is the mildest form. If the blues last for an extended period of time this may be become a chronic depression, despite the fact that it is relatively mild. Then there are the more severe forms of depression that are often incapacitating. There are times when depression comes with anxiety and a pervasive sense of hopelessness and times when a mood disorder is evidenced almost exclusively with sleep and eating disturbances and a complete lack of energy.

All types of depression are treatable but too often people suffering from depression dismiss their symptoms or get the wrong care.

In early January of this year a number of news organizations reported the results of a study published in the Journal of the American Medical Association. The teasers used by the media implied that antidepressant medications do not work to treat depression and that they are significantly overprescribed. But that is not quite what the study said. What the actual study did report was that some older antidepressants may not be as effective for treating very mild depression which is in keeping with the correct protocol.

The news reports also failed to mention that most people seeking care for depression from mental health specialists were likely to receive psychotherapy unless their depression was very severe, in which case they received a combination of therapy and medication, also in keeping with proper protocol.

And most importantly, not reported by the media was the fact that not receiving proper care for a mood disorder may exacerbate a person’s depressive symptoms but perhaps even more critically, untreated depression may cause other problems.

Over the years, it has been observed that people with heart trouble are especially at risk for developing anxiety and depression. This makes sense because whenever there is a major life change or illness and pain, and cardiac problems are among these, depression is a common co-occurrence. A National Institute of Mental Health study reported that approximately 20% of people with a cardiac diagnosis also have a diagnosable depression. More recent research suggests that not only can the pain of heart disease cause depression but depression can cause heart disease. While it makes sense that being told you have a bad heart or experiencing the chest pains that come with it can make you depressed it also is clear that being depressed can cause physical illness, and this is how it works:

Depressed individuals are loathe to exercise.

They often have a poor diet, limited social contact and a variety of other negative lifestyle habits, all of which contribute to the development of heart disease.

People who are depressed have higher levels of stress which can, in turn, lead to high blood pressure, irregular heart rhythms, damaged arteries and a weaker immune system, all of which underlie cardiac disease.

Having untreated depression has been shown to increase inflammatory markers in the blood (for example, C-reactive protein), and increase platelet reactivity both of which are high risk factors for cardiovascular illness.

People who already have a cardiac disorder and also suffer from untreated depression have an increased risk for further heart attacks or other cardiac problems.

One especially important study found that ongoing untreated depression after recovering from a heart attack increases the risk of death within six months of that first heart attack from three percent to 17 percent.

There may not be a clear link that proves that untreated depression actually causes heart attacks but so much evidence currently exists that the American Heart Association has recommended that all cardiac patients be screened for depression.

The American Psychological Association notes that depression and cardiac disease are inextricably linked and is in the process of refining the criterion for cardiac rehabilitation psychology. The emphasis is on screening and intervening for individuals who have a history of cardiac disease to monitor and aggressively treat co-occurring depressions. Perhaps the most important issue is that individuals who suffer from the symptoms and signs of depression get the proper treatment for it. It’s not only good for your mood but your heart as well.

Dr. Salamon, a Fellow of the American Psychological Association, is the founder and director of ADC Psychological Services in Hewlett, NY and a Board member of The Awareness Center. He is the author of numerous articles and several psychological tests. His recent books include, The Shidduch Crisis: Causes and Cures, published by Urim Publications and Every Pot Has a Cover: A Proven Guide to Finding, Keeping and Enhancing the Ideal Relationship, published by Rowman & Littlefield. His new book on Abuse will be available March, 2011.

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