Clinical depressions are serious disorders not only because of their psychiatric consequences, but also because of their impact on physical health. A recent article in the Journal of the American Medical Association (JAMA) indicates that depression increases the risk for stroke (cerebrovascular accidents). Other studies have demonstrated a relationship between depressions and heart disease.
Depressions increase the risk of developing coronary heart disease, and, in persons with a prior history of heart attacks, the presence of depression increases the chances of future heart attacks and the chances of dying from a heart attack. Depression also strongly and negatively influences the physical consequences of diabetes and other illnesses. Thus, depression kills not only by increasing the risk of suicide, but also by enhancing the consequences of other common medical illnesses.
Why is depression bad for health?
There are a number of possible reasons for the deleterious effects of depression on other medical illnesses. First, depressions are associated with changes in emotion, motivation, and cognition, and often result in apathy and decreased self-care. Depressed people do not maintain interest in exercise, nutrition, and social interactions. Depression can also impair compliance with recommended treatments.
Depressions also increase the levels of inflammatory chemicals in the body. Although a certain amount of these chemicals may be a healthy response to illness, high levels may contribute to risk for stroke and heart disease and worsening of those disorders.
Depressions also influence brain systems that regulate heart rhythms, sleep cycles, and other important bodily functions. For example, depressions can decrease the variability of heart rhythms, i.e., the natural speeding up and slowing down of heart rates. There is an association between low heart rate variability and increased risk of future heart problems, possibly including death.
There are likely other reasons why depressions make medical illnesses more dangerous. Thus, several mechanisms are probably responsible for the fact that depressions negatively impact the recovery from serious disorders like strokes and heart disease.
What to do if a person you know is depressed and also ill with other medical conditions such as stroke, heart disease, or diabetes?
Although it is not fully known if successful treatment of depression lowers the risk of future strokes or heart attacks, it certainly can help a person feel better. People with chronic medical illnesses who feel better are more likely to be active, eat a healthy diet, and perhaps quit smoking. People who feel better are more likely to pay attention to treating cardiac and stroke risk factors, such as high blood pressure, diabetes, and high cholesterol.
The bottom line is simple. If a person is clinically depressed, he or she should get help.
Psychotherapies, lifestyle changes, and medications all can help alleviate symptoms of depression. Not only will the person feel better as the depression lifts, but it is possible that improvement in depressive symptoms will allow the person to make appropriate lifestyle changes. Treating depression and implementing healthy lifestyle changes are likely to improve general health and help minimize future consequences of other medical disorders. Of course, this is easier said than done. Friends and families of depressed individuals can help by being supportive and encouraging the person to let their primary care doctor know that she/he is depressed. If the depressive symptoms aren't too severe, the primary care team may be able to treat the symptoms. If the symptoms are severe or if the primary care team is uncomfortable initiating treatment, they can make arrangements for the person to see a mental health professional.
This column was written by Eugene Rubin MD, PhD and Charles Zorumski MD.
