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Cardiovascular Disease and Depression

The World Health Organization (WHO) estimates that, by 2020, depression will be the second leading cause of mortality and disability in the world, with cardiovascular disease on the first place, which causes the death of 17 million people annually.


Depressed people are at a risk twice as high of suffering a heart attack compared to those who do not suffer from depression, says a study conducted in 2011 by Canadian scientists from “Concordia” University.21


In addition, according to the American Heart Association, depression occurs three times more frequently in patients with cardiovascular disease who have had an acute coronian event than among others.


The younger the person who experiences a myocardial infarction is, the higher the risk of developing depression, therefore it can be said that there is interdependence between the two disorders.


The Canadian researchers have succeeded in explaining the mechanism by which depression affects the heart.


On the one hand due to unbalanced lifestyle, inactivity, consumption of unhealthy foods,  alcohol and smoking.


In addition, depression also leads to episodes of anxiety or panic attacks and hypertension or it leads to introversion, potentially inhibiting the possibility of following appropriate treatment.


All this prevent proper blood circulation in the body and become causative factors for cardiovascular disease.


Other studies conducted in America and Australia, argue that depression seems to favor the development of deposits of fat and cholesterol in blood vessels, which are known to lead to increased risk of stroke and heart attack.


Not just depression leads to cardiovascular disease but also the other way around.


According to the American Heart Association, 15% of people suffering from cardiovascular disease are experiencing symptoms of depression. Studies have shown that, in people who have had a heart attack, depressive episodes increase the risk of death by 17%.

By comparison, in healthy people, the risk of death after a heart attack is only 3%.

The main reasons for which cardiovascular diseases favor depression are low social activity, as heart patients rarely go out of the house and do not do enough exercise, but also the dependence on doctors and drugs that increase the level of frustration of the patients.


Last but not least, the mental state of the sick is affected because the disease is unpredictable, which creates a state of permanent stress, leading to damage of the blood vessels and heart illness.


Symptoms that should worry us


Often, the symptoms of heart disease may coincide with those of depression and vice versa.


As difficulties in concentration, sleep disturbances, decreased appetite, anxiety, inner tension, irritability, fatigue or pessimism (thoughts of guilt and inferiority) occur, depression followed by heart disease may appear.22


A significant percentage of patients who suffer from depression, with or without associated cardiovascular disease, are not diagnosed on time or receive inadequate therapeutic care.


Therefore, the doctor holds a key role in the early detection of depressive symptoms and guidance of these patients to a psychiatric service.


In particular, for patients with a history of cardiovascular events, the cardiologist may recommend a psychiatric evaluation to establish a diagnosis of depression.


How to properly treat the two disorders?


The most used and effective therapeutic approach has proven to be the combination of psychological and pharmacological treatment.


Psychological treatment can be one of the following forms of psychotherapy: cognitive behavioral therapy or interpersonal.


In some cases, supportive counseling has proven to be the best method of psychological treatment.


Regarding pharmacological treatment, the chosen antidepressant medication for a patient with cardiovascular disease must have the best safety profile in terms of adverse effects.


The psychiatrist will have to take into account not only the effects and interactions of various antidepressants, but also the adverse effects that may occur between the medication prescribed by the cardiologist for cardiovascular disease and the antidepressant medication which the patient wants to follow.


These interactions can lead either to a lack of efficacy of both the medications for cardiovascular disease and the ones for depression or, sometimes, to an increase of the effect the drugs have, getting the patient to feel very weak, not having the power to do anything (conditions given by the extreme decrease of the blood pressure, for example) or experience nausea, stomach pain or other events, due to the actions of antidepressants.


In this situation, the doctor will have to choose cardiovascular drugs and antidepressants that do not interact and have an excellent safety and tolerability profile.


Doctors who provide care to patients with heart disease should also be familiar with the manifestations of depression and make the patiens aware of this condition, especially because it was shown that a number of drugs used to treat cardiovascular disease are inducing depression.


This is important because depression adversely affects the evolution of cardiac disease, and also affects all the aspects of a patient’s life, including family and personal relationships, education, career, business and general health.

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