Research shows that depression is an independent risk factor for cardio-vascular disease, equal to smoking. Yes, long-term, depression is as harmful as smoking. Think heart attacks, cholesterol, diabetes, obesity, and high blood pressure.
Part of the reason is that depression causes a pro-inflammatory state. It activates the inflammatory cascade so that events like heart attacks and strokes are more likely to occur. The other explanation is that avoidance, which is part of depression, results in binge eating, not exercising, and skipping medications. This passive withdrawal from proactive problem solving is characteristic of depression—being stressed or burned out.
That is why I work closely with primary care doctors using the Collaborative Care model. This refers to psychiatrists working with primary care doctors, specialists and other therapists as a team. This is the most significant change to psychiatry practice in the past 10 years.
Practically speaking, this means three things:
- Trying to improve the depressive symptoms as quickly as possible because they are seen as biologically noxious to the body. This supports the use of pharmacogenomic testing to see which medications are more likely to be successful and which are more likely to cause side effects. Getting on the right medication the first time is vital to improving outcomes. This testing is done with a painless cheek swab. Increasing the dose of the medication as fast as is reasonably possible is also helpful.
- Stress contributes to the release of stress hormones such as cortisol. So it worsens cardiovascular risk. Because chronic stress or burnout overlaps with depressive symptoms, it is important for psychiatrists to address burnout as a specific goal of therapy. Buffers against burnout including exercise, improving work and relationship challenges. Toxic relationships are really and having a good night’s sleep.
- The psychiatrist’s need to coach patients about cardiovascular risk factors such as blood glucose, high blood pressure, hyperlipidemia and smoking. Improving these needs to be a goal of the therapy.
In order to achieve this, therapy needs to have short and long term goals. The short terms goals are to improve depressive symptoms within about 10-12 sessions. The longer term goals are to improve cardiovascular health over a period of one, five, 10 or, 20 years.
As I say to my patients, “What good will it do if we help your depression but in a year’s time, or 10 years time, you get diabetes or a stroke, which we could have prevented?”
The role of a psychiatrist as a health coach is new. Most psychiatrists practice in small offices, isolated from the rest of the medical profession. They don’t share their medical notes with other doctors because they are seen as being super-private. This is a historical remnant of psychiatry related to its perceived stigma. This needs to be changed given its role in promoting overall wellness.
Bottom line: you and your psychiatrist should be speaking about cardiovascular risk and your psychiatrist should be speaking to your PCP, specialist and other therapists. It’s vital to improving long term cardio-vascular outcomes.