In recent years, scientists have attempted to establish a link between depression and heart disease. It’s proven that a diagnosis of heart disease or experiencing a heart attack, stroke, or other cardiac event can lead to depression, but the reverse is not as clear-cut. Can depression cause heart disease?

Adults with a depressive disorder or symptoms have a 64 percent greater risk of developing coronary artery disease, according to the Depression and Bipolar Support Alliance. But why? First, let’s consider the risk factors involved:

1. Depression is a Risk Factor for Cardiovascular Disease
   When people think of risk factors for heart disease, they usually think of smoking, excessive alcohol use, physical inactivity, and obesity — not depression. But when a person experiences depression, which may also be accompanied by anxiety or stress, their heart rate and blood pressure rise, blood flow to the heart slows, and the body produces higher levels of cortisol (a stress hormone). Over time, these effects can lead to heart disease.
   
2. Depression Affects Behavior and Lifestyle Choices
   Depression can make everyday life difficult, to say the least. Often, daily life for those who are clinically depressed is reduced to the bare minimum to get by. Smoking and drinking may be used as coping mechanisms; exercising and eating healthy may seem like too much to handle; and controlling chronic or new health problems such as diabetes and high cholesterol may be ignored. People with depressive symptoms may also fail to take any medications they are on regularly or properly. As a result, those who are depressed may gain weight, suffer internal inflammation, and become unfit, which can contribute to hypertension and high blood pressure, leading to cardiovascular disease.
   
3. Depression Leads to Apathy About Overall Health
   People who suffer from clinical depression may choose to ignore signs of heart-related problems, such as chest pain, shortness of breath, and arm or back pain. Worrying that their symptoms may lead to a serious health diagnosis can be overwhelming, which may lead them to forgo seeing a doctor. Depression and heart issues can also share symptoms, such as fatigue and anxiety, making a person assume their symptoms are related to their depression and disregard them as unimportant.

Biological Evidence
In addition to behavioral and lifestyle factors that affect heart health, there is evidence of biological mechanisms that link both coronary heart disease (CHD) and major depressive disorder (MDD). A 2016 study by Arup K. Dhar and David A. Barton suggests that “Psychological stress experienced by people suffering from MDD can also cause deregulation in the sympathetic nervous system and hypothalamic-pituitary-adrenal (HPA) axis. This in turn has a number of deleterious downstream effects, including the development of hypertension, left ventricular hypertrophy, coronary vasoconstriction, endothelial dysfunction, platelet activation, and the production of pro inflammatory cytokines. The potential consequence of this is an elevated risk in ventricular arrhythmias and MI (myocardial infarction).”

Medications that help treat mental disorders may also account for an increase in heart disease risk. Certain medications may increase weight gain, thereby putting a greater burden on the body’s arteries. In addition, antidepressants, which work by changing the body’s response to chemicals that affect mood, can lead to an increase in blood pressure. It’s therefore important for patients to discuss with their doctors how their lifestyle and medications may impact their risk for developing heart disease.

Practice Self-Care
To lower stress levels, improve general physical health, and help manage depression, the following can help:

> Deep breathing exercises
> Positive visualization and engaging in positive self-talk
> Connecting with others
> Getting plenty of sleep
> Meditating
> Journaling
> Being physically active for 30 minutes a day
> Eating regular, healthy meals

These may not be cures for depression or heart disease, but adding them to a doctor’s care, medication, and/or therapy may help patients feel better both mentally and physically.

Stay Vigilant
Heart disease has been the leading cause of death every year in the United States for decades. And as mental health disorders have skyrocketed in recent years, it’s now clear that the risk factors for CHD include depression. Many healthcare professionals have begun calling depression a public health problem and advocating for annual screenings by primary care doctors. While there is no one course of action to take for all patients, combatting these diseases starts with education and discussion.

For more information, visit: https://www.aapc.com/blog/87294-depression-and-heart-health/