Alzheimer's, Dementia & Mental Health
Depression Can Lead to Cardiac Death for Women with
No Prior Signs of Heart Disease
Women with more severe depressive symptoms or who
reported taking antidepressants were at higher risk
March 11, 2009 - Relatively healthy women with
severe depression are at increased risk of cardiac events, including
sudden cardiac death (SCD) and fatal coronary heart disease (CHD),
according to new data published in the March 9, 2009, issue of the
Journal of the American College of Cardiology.
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Researchers at Columbia University Medical Center
and Brigham and Women’s Hospital in Boston say they have found a strong
correlation between depressive symptoms and cardiac events in women.
A team led by William Whang, M.D., of the
cardiology division at Columbia University Medical Center, found that
much of the relationship between depressive symptoms and cardiac events
was mediated by cardiovascular disease risk factors, such as high blood
pressure, high cholesterol and smoking.
Dr. Whang and his colleagues prospectively studied
63,469 women from the Nurses Health Study who had no evidence of prior
heart disease or stroke during follow-up between 1992 and 2004.
Self-reported symptoms of depression and use of
antidepressant medication were used as measures of depression. To best
identify those with clinical depression, researchers specifically
examined women with the most severe symptoms defined by a validated
5-point mental health index score or regular antidepressant use.
The study found that women with more severe
depressive symptoms or those who reported taking antidepressants were at
higher risk for SCD and fatal CHD.
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How do older
adults experience depression?
White males 85 and older have the highest suicide rate
Depression is not a normal part of aging, according to the
National Institute of Mental Health, but when senior citizens
have a depression it may be overlooked, because older people
show different and less obvious symptoms. They also may be less
willing to acknowledge feelings of sadness or grief.
“In addition,” according to the NIMH, “older adults may have
more medical conditions such as heart disease, stroke or cancer,
which may cause depressive symptoms, or they may be taking
medications with side effects that contribute to depression.
"Some older adults may experience what some doctors call
vascular depression, also called arteriosclerotic depression or
subcortical ischemic depression.
“Vascular depression may result when blood vessels become less
flexible and harden over time, becoming constricted.
"Such hardening of vessels prevents normal blood flow to the
body's organs, including the brain. Those with vascular
depression may have, or be at risk for, a co–existing
cardiovascular illness or stroke.
“Although many people assume that the highest rates of suicide
are among the young, older white males age 85 and older actually
have the highest suicide rate.
"Many have a depressive illness that their doctors may not
detect, despite the fact that these suicide victims often visit
their doctors within one month of their deaths.
“The majority of older adults with depression improve when they
receive treatment with an antidepressant, psychotherapy, or a
combination of both.
“Research has shown that medication alone and combination
treatment are both effective in reducing the rate of depressive
recurrences in older adults.
"Psychotherapy alone also can be effective in prolonging periods
free of depression, especially for older adults with minor
depression, and it is particularly useful for those who are
unable or unwilling to take antidepressant medication.
>>
More at NIMH on Depression |
In particular, women with clinical depression were
more than twice as likely to experience sudden cardiac death.
Surprisingly, this risk was associated more strongly with antidepressant
use than with depressive symptoms.
Dr. Whang stresses that although the relationship
between antidepressant medicines and SCD merits further investigation to
determine whether antidepressant medications directly increase the risk
for heart rhythm disorders, at present the benefits of appropriately
prescribed antidepressants outweigh the risk of sudden cardiac death.
"We can’t say antidepressant medications were the
cause of higher risk of sudden cardiac death. It may well be that use of
antidepressants is a marker for worse depression,” Dr. Whang said.
“Our data raise more questions about the mechanisms
by which depression is associated with arrhythmia and cardiac death."
Overall, the study findings reinforce the need for
patients with depression to be monitored closely for risk factors for
coronary heart disease, Dr. Whang said, since management of these risk
factors can reduce the risk for mortality from coronary heart disease
and sudden cardiac death.
"It’s important for women with depression to be
aware of the possible association between depression and heart disease,
and work with their health care providers to manage their risk for
coronary heart disease," he said.
About Columbia
Columbia University Medical Center provides
international leadership in basic, pre-clinical and clinical research,
in medical and health sciences education, and in patient care.
Established in 1767, Columbia's College of Physicians & Surgeons was the
first institution in the country to grant the M.D. degree and is among
the most selective medical schools in the country. Columbia University
Medical Center is home to the largest medical research enterprise in New
York City and state and one of the largest in the United States. For
more information, please visit
http://www.cumc.columbia.edu.
