It's no surprise that some heart disease patients go into deep depression after a heart attack or other critical care event, but now researchers are finding evidence that heart healthy patients who suffer from depression are more at risk for heart disease. As part of our week long series on depression, ideastream health reporter Gretchen Cuda explains what researchers are learning about how the ills of the body and the mind are linked.
CUDA: Mark Penn is a cardiologist at the Cleveland Clinic and the director of the Clinic's Heart brain Institute - a relatively recent clinical department devoted to studying the way the heart and the brain interact. He says both heart and brain science have come a long way in recent decades and physicians are now beginning to more fully appreciate the interactions between the brain and various organs like the heart, interactions that can have important medical consequences, particularly when it comes to mood disorders.
PENN: What's become quite clear over the last several years is that patients who are depressed do worse with heart disease and have a higher incidence of myocardial infarction - heart attacks and death
CUDA: In fact, according to a recent study from Washington University School of Medicine in Saint Louis, men with depression were twice as likely to develop heart disease compared to men with no history of depression. Some studies conclude that the main reason for this is that depression often leads to poor health behaviors, especially decreased physical activity and exercise…factors that increase the risk of heart disease. But others in the field are convinced there's more going on than that. Researchers at Indiana University and elsewhere have found that depression leads to elevated inflammatory proteins in the body. The Cleveland Clinic's Mark Penn says that's solid evidence that what's going on in the brain of depressed patients may be linked to heart disease.
PENN: The brain- through the nervous system that then feeds into the rest of the body- can actually control the level of inflammation --of atherosclerosis or hardening of the arteries we have--and that depression changes the way in which the brain interacts with those nerves and then ultimately the risk for disease
CUDA: It works like this: A large nerve called the vagus nerve transmits information back and forth between the internal organs and the brain. When patients are depressed, the nerve becomes less active and the communication breaks down. This triggers the body's natural defense mechanism - inflammation - which can lead to hardening of the arteries other disease processes linked to increased inflammation. And what's more, changes in the vagus are linked to other metal stressors related to depression like post traumatic stress.
PENN: Depression decreases the ability of the vagus to fire - so does post traumatic stress disorder. So many things that we know really weigh on us in a daily way actually affect the vagus which then affect our risk for disease
CUDA: It explains a lot says Penn-for example- when an elderly person loses a spouse and becomes depressed the remaining spouse often dies shortly afterward - and no one really knows why. But if normal grief turns to major depression, it increases inflammation. In a population which already has a lot of disease like the elderly --this can dramatically increase the risk of death.
The American Heart Association and the American College of Cardiology now recommend that all heart patients be screened for depression Among the treatments recommended for heart disease and depression is to lower stress levels in the patients. Cardiologist Mark Penn says biofeedback can be an effective therapy - that involves the patient learning to consciously control involuntary body responses such as heart rate, brain activity, or blood pressure. Veteran psychologist Michael McKee , also of the Cleveland Clinic, uses biofeedback with many of his patients who suffer from depression or anxiety. He says that understanding of how the brain and body work in concert and using that information to heal is the ultimate goal.
MCKEE: I think we'll finally be looking at the whole person. That's been the goal all along-to look at the whole person - not look at a symptom
CUDA: And Mark Penn says that goes for psychiatrists, neurologists as well as his specialty - cardiology.
PENN: We can work on the heart all we want, but if they are still depressed we're not going to make them feel better.
CUDA: Research has shown that therapies that involve the mind -- things like biofeedback and psychotherapy can not only successful treat depression, but they physically change the brain. Doctors say its not such a stretch to assume that mood can effect other organs of the body as well. But while progress is being made understanding how depression harms the heart, studies have yet to show that successful treatments for depression can help reverse the damage. Researchers say the field is still in its early stages, but they are hopeful that this sort of multidisciplinary approach to medicine will one day lead to more answers than questions.
Gretchen Cuda, 90.3