The connection between heart disease and depression is a two-way street. Depression is not just hard on the mind; it takes a toll on the heart, too. Studies also show that depression is about three times more common in people who've had a heart attack. And many who have atrial fibrillation or who have had a stroke experience periods of depression.
Doctors who are focused on the heart, however, may not have expertise in diagnosing and treating depression. By the same token, psychiatrists treating depression may not address their patients' heart health. Angelos Halaris, MD, PhD, medical director of adult psychiatry and a professor in the psychiatry and behavioral neurosciences department at Loyola University's Stritch School of Medicine in Chicago, is working to change that.
Dr. Halaris proposes that psychiatrists and cardiologists work together in a subspecialty he has dubbed psychocardiology.
"Unless we have cardiologists who understand psychiatric issues, and psychiatrists who understand cardiovascular issues, we are not really making any progress," says Halaris, who is the lead editor of the book, Inflammation in Psychiatry. "I'm not talking about treating patients after the fact, when a condition has set in already. I'm talking about anticipating outcomes and, if possible, preventing serious outcomes. So, the emphasis here is not just on treatment, but also on prevention."
The Heart Disease - Depression Link
The link between heart disease and depression can best be described as a vicious cycle. Research shows depression triggers chronic inflammation, which can increase your risk for heart disease. In turn, depression after heart attack, atrial fibrillation, or stroke is common, leading to more harmful effects on your heart health.
According to an article published in the Journal of the American College of Cardiology, more than a million people in the United States currently have both heart failure and clinical depression. The article also points out that, over time, untreated depression is a significant risk factor for death among people with heart failure.
A recent study from Germany showed that people with atrial fibrillation have a higher burden of depression symptoms than those free of this heart condition. And research published in the Journal of the American Heart Association found that among 934 people with heart disease, those with high levels of anxiety were two times more likely to die. For those with both anxiety and depression, the risk for death was three times greater.
Treating Depression to Prevent Heart Disease
Exactly how depression leads to heart disease has been the focus of Halaris's work. He compares the body's reaction to depression with a nation defending itself from an impending invasion.
"The immune system gets literally alarmed by what is going on in the body," he says. "Our nervous system perceives psychological stress as a threat."
Stress causes the body to produce excessive amount of the hormone cortisol, and "cortisol has the potential to cause toxic effects if it is constantly released due to the demands of ongoing stress," Halaris says. In response to stress, the immune system also produces proteins called cytokines. This is helpful at first, but over time, a chronic inflammatory response can lead to arteriosclerosis (hardening of the arteries) and heart disease.
"The blood vessels begin to undergo alterations that lead to thickening and stiffness, along with other changes that happen in the platelets and lipids that circulate in the blood stream," notes Halaris. Eventually, this can lead to heart attack or stroke.
In conducting his research, Halaris found that levels of one cytokine linked to heart disease, known as interleukin-6, were significantly higher in the blood of people suffering from depression than in healthy people's blood.
Treatment with antidepressants can help reverse the body's inflammatory response to depression. "They relieve depression and associated anxiety," Halaris points out. "Therefore, the risk of developing cardiovascular disease is diminished, if not outright abolished."
This is particularly significant because clinical depression often develops early in life, in people's twenties and early thirties. Diagnosing and treating depression early on can help prevent heart disease later in life, notes Halaris.
The New Role of Psychocardiology
The challenge in addressing the link between heart disease and depression is the fact that doctors often work in isolation: Psychiatrists treat depression, and cardiologists treat heart disease.
Halaris would like to see that change. In November 2012, at a joint congress of the World Psychiatric Association and International Neuropsychiatric Association in Athens, Greece, he became the first to formally propose the creation of a new psychocardiology subspecialty. According to Halaris, the subspecialty would lead to:
- The creation of multidisciplinary teams with the training and expertise needed for the early detection and treatment of heart disease risk in psychiatric patients and the diagnosis of depression in those with heart disease
- Continuing education for doctors on the proper use of medications in heart patients who have psychiatric disorders
Heart disease and depression are two of the world’s leading health problems, and Halaris points out that a psychocardiology subspecialty would help tackle both major health issues.
"We need to have the two specialties working hand in hand," he says. "By coining this concept and by developing training programs for this subspecialty, we will save lives and reduce health care costs. It's a win-win situation, no matter how you look at it."
Halaris says he has received an enthusiastic response to his proposal. Although it's still too early to launch a formal subspecialty training program, he says he would like to see teams of psychiatrists and cardiologists come together and form multidisciplinary teams representing cardiology, internal medicine, psychiatry, and psychology in their own practices, hospitals, and medical centers, with the goal of developing programs to address the complexity of these conditions.