My Heart is Aching, I Could Lie Down and Die

Linking Depression and Coronary Heart Disease

By Dr. Barbara Briner DAOM, L.Ac., MD (Switzerland)

Major Depression can make its first appearance at any age; however, it shows an average age onset in the mid-twenties. Some may have just one episode while others may continue to suffer from recurrent episodes years apart or even experience increasingly frequent episodes as they grow older. Although depression, especially major depression, occurs most frequently in young adults, projections show this tendency is shifting toward the older adult population. In addition, it is the population suffering from depression at retirement age that shows the highest suicide rates. [1] If continuing on its current course, depression is expected to become the second leading cause of disease world-wide by the year 2020.[2] While this disease already carries a high suicide risk of about 15%, epidemiological evidence shows a fourfold increase in death rates in individuals over age 55. [3]

Recent studies show suicide is just one way an untreated depression can become fatal in that age group. Cardiologists have discovered a relationship between depression and coronary heart disease. They have been able to establish depression as its own independent risk factor for morbidity and mortality when screening for coronary heart disease (CHD). That means that depression may now be considered a predictive factor to judge the prognosis for CHD. In other words, a depressed person has a higher risk to suffer and die from coronary heart disease. The National Health and Nutrition Examination Survey, conducted in 2001 by Ohio State University College of Medicine and Public Health, examined 5007 men and women free of coronary heart disease using a standard depression scale. [4] Through follow-up studies over years, the researchers were able to show, that depressed women and men had a higher risk incidence for coronary heart disease (and men had also a higher CHD mortality risk) compared with the non-depressed population. That means depression has to be taken in account as an antecedent to heart disease. These results were also confirmed in several other studies. For example, an Italian research team conducted a prospective community based cohort study in 2005 examining the relationship between depression and CHD. They recruited 5632 Italians, 65 years and older, and evaluated the association between depressive symptomatology, cardiovascular events and mortality in elderly persons. They found that depression was associated with a higher incidence of fatal and non fatal CHD events. [5]

It is common knowledge that it is more probable to fall ill from coronary heart disease in the second half of life. It has been shown that the risk to experience a cardial event increases for a depressed person after the age of 55. It is therefore apparent that diagnosis and treatment of depression is very important. Because this age group is frequently multi-morbid, they often already have extensive, pre-existing prescription lists of daily medications. Adding additional anti-depressant medication can be a challenge. However, a good argument can be made for adding antidepressants. Certain serotonin specific re-uptake inhibitors might offer a double protection since they work not only as antidepressants, but also have a thrombolytic effect (blood thinning). Some of these anti-depressants therefore can also be classified as cardio protective.[6]

Unfortunately, antidepressants can not always guarantee relief from depressive symptoms. Therefore, a multi-disciplinary approach with the fifty and older age group is beneficial. Acupuncture has shown promising results in multiple studies when it comes to treating depression. In fact, a British survey conducted by the Acupuncture Resource Center in 2002 found that acupuncture frequently had similar effectiveness as pharmacotherapy for depressive disorders.[7] Here in the US, J. Allen PhD and R. Schnyer Dipl.Ac, working through the Behavioral Science Department of Psychology at the University of Arizona, conducted a ground-breaking and impressive study using acupuncture to treat depression with marked success.[8] In review of their results, they suggest acupuncture as a valid modality for recurrent major depression pointing out that “compared to other empirically validated treatments, acupuncture designed specifically to treat major depression produces results that are comparable in terms of rates of response and of relapse or recurrence.”[9] They state two interesting points: first, using acupuncture to treat recurrent major depression can be as successful at achieving symptom relief as psychotherapy or pharmacotherapy and second, after treatment ends, the symptom free interval holds comparably long before the next depressive episode occurs.

In Chinese medicine it is said that the mind is ‘housed’ in the heart, connoting a physical-emotional-mental relationship that is also being explored in western medicine. The popular English saying “my heart is aching’ refers to this relationship between the physical and emotional experience. Through this network of counter-influence, the growing field of Integrative Medicine may be able to offer keys in enhancing health and life experience, respecting both emotional and physical expressions as two sides of the same coin.

[1] Compton WM, Conway KP, Stinson FS, Grant BF. Changes in the prevalence of major depression and comorbid substance use disorders in the United States between 1991-1992 and 2001-2002. Am J Psychiatry 2006; 163(12):2141-7.

[2] Murray JL, Lopez AD, editors. Summary: the global burden of disease. Boston (MA): Harvard School of Public Health; 1996.

[3] DSM IV TR, American Psychiatric Association march 2007, p. 371-373

[4] Ferketich AK, Schwartzbaum JA, Frid DJ, Moeschberger ML. Arch Intern Med.2001 Febr 12; 161(3):485-6. Depression as an antecedent to heart disease among women and men in the NHANES I study. PMID:10809028(PubMed)

[5] J Gerontol A Biol Sci Med Sci. 2005 Jan;60(1):85-92 Depressive Symptoms and development of coronary heart disease events: the Italian longitudinal study on aging. PMID: 15741288(PubMed)

[6] Serebruany VL, Suckow RF, Cooper TB, O'Connor CM, Malinin AI, Krishnan KR, et al. Relationship between release of platelet/endothelial biomarkers and plasma levels of sertraline and N-Desmethylsertraline in acute coronary syndrome patients receiving SSRI treatment for depression. Am J Psychiatry 2005; 162(6):1165-70.

[7] British Acupuncture Councel, Depression, Anxiety and Acupuncture, the evidence for effectiveness, Briefing Paper Nr 9 February 2002

[8] J B Allen, Psychiatric Times, Depression and Acupuncture a controlled clinical trial, March 2000 Vol 17, Issue 3

[9] S.M.Gallagher, J.J.B.Allen, S.K.Hitt, R.N. Schnyer, R. Manber, Six-month depression relapse rates among women treated with acupuncture, doi: 10 1054/ctim 2001 0470 Complementary Therapies in Medicine, Volume 9, Issue 4, Dec 2001, Pages 216-218.