by Brenton Bauer, MD 2012
One word: Psychosomatic. Think about it…what comes to mind? The majority of people, at least transiently, see the words “crazy” or “it’s all in your head” flash across their internal teleprompter. To clarify, psychosomatic is not medical speak for “crazy”; in fact, there is an entire subspecialty of psychiatry that deals with psychosomatic medicine. The field of psychosomatics is interested in the interface between the mind and the body and the dynamic interplay that goes on between the two. Recently, the Los Angeles Times published an article that discussed a particular psychosomatic link between depression and heart disease. We’d like to discuss this association and illuminate the topic with the latest research publications (not that we have anything against the way the LA Times covered it. We just thought you might be interested in the hard science).
What is Depression?
That’s easy: feeling down, right? It’s true that “feeling down” (i.e. experiencing a depressed mood) is a part of the criteria for depression, but psychiatrists have created an extensive set of criteria for establishing the diagnosis of Major Depressive Disorder. According to the Diagnostic and Statistical Manual 4th ed. (i.e. the Bible of Psychiatry), Major Depressive Disorder is one of the mood disorders in which an individual suffers from at least one episode of Major Depression. A Major Depressive Episode is diagnosed when an individual has at least five target symptoms of depression including:
- depressed mood (most or all of the day, nearly every day)
- disinterest or lack of pleasure in activities
- significant weight fluctuations
- sleep disturbances
- motor slowing/agitation
- fatigue/diminished energy
- feelings of worthlessness/inappropriate guilt
- diminished concentration
These symptoms must be present for at least two weeks, must cause significant distress/functional impairment, and cannot be caused by substance use, medical illness, or better accounted for by another psychiatric disorder.
How common is Depression?
Depression is actually a relatively common illness with a lifetime prevalence of about 7-12% for men and 20-25% for women (meaning that 1/9th of men and 1/4th of women will experience depression at some point in their life). Furthermore, there are external factors that can increase your risk of suffering from depression (for example: chronic medical illnesses, substance abuse, previous physical/sexual abuse, etc.). If any form of alcohol or substance abuse has lead to depression, quitting this abuse can be key in overcoming the depression. There are plenty of facilities nationwide that can help with this; whether you need detox centers in New York, or Florida rehab centers, help shouldn’t be hard to find.
We get it. Depression is common. How does it affect my heart?
It turns out that research investigating this connection is not new as there have been approximately 60 prospective research studies reporting a similar association between depression and heart disease in the past 40 years. It is reported that in patients having suffered a heart attack, there was a 3-fold increased prevalence of depression. Also, research has shown that depression can:
- Worsen the prognosis of patients with coronary artery disease
- Place patients at increased risk of developing heart disease to begin with
Increase your risk of cardiac and overall mortality
While the pathophysiology (medical speak for underlying reason) behind this association is not entirely understood, there are a few hypotheses. One hypothesis is that depression is associated with higher levels of corticotropin releasing hormone (a hormone released from the hypothalamus in the brain) that then stimulates higher levels of another hormone, cortisol, to be released into your blood stream. Increased cortisol causes your body to deposit more visceral fat and leads to higher levels of circulating fatty acids. This perfect storm increases your risk of developing high blood pressure, diabetes, and elevated cholesterol, all of which are well-defined risk factors for heart disease. Another hypothesis is that depression is associated with higher levels of two hormones, adrenaline and noradrenaline, in the blood stream. These hormones are associated with increased platelet activation and increase your risk of forming a blood clot. What’s the big deal with a clot? A blood clot in a vessel supplying oxygen and nutrients to you heart is one of the most common causes of a heart attack. Not something we’re interested in experiencing. Finally, some hypothesize that depression stimulates the vagus nerve, increasing your propensity for a ventricular arrhythmia (when the pumping chambers of the heart don’t contract normally because of an electrical problem). These arrhythmias increase the risk of cardiac death in patients suffering from a heart attack.
What is being done about it?
That’s a good question. While there is still a lot of uncertainty surrounding the topic (i.e. there are no official evidence-based guidelines for physicians), changes are beginning to be made. First of all, the Joint Commission (an organization that regulates hospitals) is now recommending that all hospitals institute a global depression screen for all hospitalized patients. This screening will allow for more at-risk patients to be identified and be seen by a mental health professional (psychiatrist) who can further evaluate and treat them if necessary. Furthermore, newer literature is evaluating the best questions for primary care physicians to ask patients with the goal of detecting at risk individuals that would benefit from treatment.
The Take Home Message
Psychosomatic does not equal “crazy;” it describes how the mind affects the body and vice versa. This is eloquently seen in the link between depression and heart disease. What can you do about it in your daily life? First, engage in a heart-healthy lifestyle, which includes things like a balanced diet, plenty of exercise, and managing any risk factors that might put you at increased risk for heart problems (like smoking). Second, as we have attempted to highlight, don’t neglect the importance of a sound mind. Be cognizant of your mood and feelings. Think about how you are coping with stressors in your life. Don’t be afraid to find help if you need it. It’s important for your mind your body.
Questions? E-mail the Author: email@example.com
- American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.
- Kemp, David MD, et al. “Heart Disease and Depression: Don’t Ignore the Relationship”. Cleveland Clinic Journal of Medicine. 2003; 70:9. 745-761.
- Lichtman, J, et al. “Depression and Coronary Heart Disease: Recommendations for Screening, Referral, and Treatment: A Science Advisory From the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research: Endorsed by the American Psychiatric Association”. Circulation. 2008; 118; 1768-1775.