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Your Heart, Your Mind-The Link

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People have been learning about the link between heart disease and depression since the 1970s, when researchers showed a connection between stress and sudden death. This led to the conclusion, in the 1980s, that major depressive disorder was an independent risk factor for major cardiac events in people with coronary artery disease.

Like the classic question of the chicken and the egg

As time goes on, researchers are beginning to believe that the cause and effect of depression and heart disease may be even more intertwined than they had understood.

One simple theory is that people who are depressed are less likely to take care of their health. They may not seek treatment for heart problems, and even if they are prescribed medication, they may not take it as they should. They're also more likely to drink more alcohol, to get less exercise and to smoke.

It's also been noted for quite a while now that depression can result after a heart attack occurs. This really isn't surprising when you think about it. A heart attack makes people worry about all kinds of things-whether they'll ever have good health again, whether death is closer than they thought, etc.

But some researchers now believe that it goes deeper than these somewhat logical conclusions. For example:

Increased inflammation

Depression itself, independent of a cardiac event, can cause low levels of inflammation throughout the body. Over time, this inflammation can damage blood vessels and arteries. The vessel walls become stiffer, and sometimes pieces break off, forming blood clots that can cause heart attacks.

When you have a heart attack, your body releases molecules that trigger inflammation. This is a sort of message to the body that there's been a serious event and it's time to be quiet and rest. That period of needing to lay low and conserve energy may trigger depression in some people.

Studies have shown that people who suffer from depression have increased levels of some inflammatory chemicals, and that depressed people who have had heart attacks have higher levels of inflammatory chemicals than heart attack patients who are not depressed.

Higher levels of cortisol

People who have depression often produce high levels of the hormone cortisol, which is related to stress. This is a hormone that's useful when danger strikes, because it puts you on alert and increases your heart rate. But if cortisol is constantly flowing through the body, in can cause high blood pressure, higher levels of insulin, more fat in the abdomen and higher bad cholesterol. All of these elements can damage the cardiovascular system.

Lower serotonin levels

Many people who suffer from depression have low levels of a neurotransmitter called serotonin. There's an entire class of anti-depressant drugs that increase the amount of serotonin for the brain. Researchers have been finding that low serotonin levels seem to be related to a higher heart rate, which in turn can increase blood pressure and increase the risk of heart disease. Studies of depressed monkeys have shown reduced levels of serotonin in the brain in the areas that control mood and heart rate. Over time, the monkeys with low serotonin are more likely to develop atherosclerosis, or hardening of the arteries.

Additionally, when serotonin levels are low, your blood tends to be thicker, and that makes it harder for your heart to pump. Studies are now ongoing to determine whether serotonin-boosting drugs can help people who have cardiovascular problems.

Underscoring the need for heart and mind care

If you or your loved ones suffer from depression, it's important to make sure to asses the health of your heart. And if heart problems are already present, pay attention to the mental health aspect.

It's not really surprising that depression and heart disease are linked. Think of the expression "a heavy heart." Your heart feels heavy when you feel sad, or when problems are weighing on you. This is something that's been known for ages and ages. But now, with a deeper understanding of the heat-mind connection, there are so many things that medicine can do about it.



Source:
Psychiatric News, 5 August 2005; Archives of Internal Medicine, 28 November 2005; American Journal of Psychiatry, November 2005, The National Institute for Mental Health;



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