Treating Hearts and Minds

A new look at an old study sheds light on one of the most dangerous two-way streets in medicine: the tendency of heart disease to cause depression and depression to cause heart disease. The evidence suggests that common antidepressants can safely reduce the risk of recurrent heart attacks in depressed cardiac patients.

The link has been one of the most puzzling mind-body problems. Even among those in excellent physical health, depression can double the risk of a heart attack. And among those who suffer a heart attack and then get depressed, the risk of death rises 350 percent. Unfortunately, 20 percent of heart patients develop depression within months of a heart attack.

Reporting in the Archives of General Psychiatry, researchers state that selective serotonin reuptake inhibitors (SSRIs) such as Prozac, Paxil and Zoloft can be used with confidence to treat both problems at the same time.

Alexander H. Glassman, chief of clinical psychopharmacology at New York State Psychiatric Institute, initially studied nearly 400 depressed heart patients for four years. The data analysis suggested that Zoloft could lower the risk of death after a heart attack, but the sample was too small to be definitive. Glassman says his study did prove that SSRIs could be safely prescribed to heart patients.

A reanalysis of data from a three-year study of 2,000 patients shows that SSRIs do help depressed heart patients. The research shows that patients who took SSRIs were 43 percent less likely to suffer another heart attack.

Exactly how hearts and minds are so tightly linked is not clear. The strongest evidence suggests that depression wreaks changes throughout the nervous system and limits the capacity of the heart to adjust its pumping rate in response to situational demands. Cardiac patients are often fragile, and depression magnifies their susceptibility. SSRIs, it turns out, help both hearts and minds regain some of their necessary flexibility.