Cardiovascular disease remains a leading cause of death worldwide. several risk factors have been identified for the development of cardiovascular disease. the link between depression and cardiac disease has been extensively researched over the past two decades. there is mounting evidence that depression is a risk factor for cardiovascular disease and outcomes have been noted to be worse in patients with cardiac disease who are depressed. depression has been associated with blood pressure changes, altered heart rhythms, altered blood clotting and elevated insulin and cholesterol levels.
Depression is a serious medical condition that affects the way a parson thinks, feels and carries out everyday functions. it affects 6% of men and 18% of women in the general population. symptoms of depression include feelings of guilt, hopelessness, worthlessness, persistent sad or anxious mood, loss of interest or pleasure in activities that were once enjoyed, decreased energy, fatigue, poor appetite, insomnia or oversleeping, restlessness, irritability, difficulty remembering, concentrating and making decisions, weight changes and thoughts of death or suicide attempts.
Heart disease includes two conditions called angina pectoris and acute myocardial infarction, also known as a heart attack. Interruption of the blood supply to the heart via the coronary blood vessels as result of narrowing or clogging of these vessels leads to coronary artery disease. The heart responds to this disease with pain called angina. This pain is felt in the center of the chest and radiates to the jaw, left arm and shoulder. When the blood supply is cut off completely to the heart and the heart tissue starts to die, the result is a heart attack.
Research has shown that people with heart disease are more likely to suffer from depression than healthy people and people with established depression are at greater risk of developing heart disease. People with heart disease who are depressed have an increased risk of death after a heart attack compare to those who are not depressed. After a heart attack the incidence of major depression is from 15% to 20%, and an additional 27% of patients develop minor depression.
A number of mechanisms have been suggested for the increased risk for heart disease seen in depressed persons. These mechanisms include excess cortisol, altered autonomic function and increased platelet activation. Increased brain activity especially in the hypothalamic-pituitary-adrenocortical axis and increased platelet activity commonly seen in depressed persons ultimately result in vascular damage and plaque formation. Patients with depression commonly show a decreased variability in their heart rate brought about by altered autonomic function. Decreased heart rate variability is associated with greater variation in blood pressure, increased risk of ventricular arrythmias and sudden death.
Diagnosing depression in persons with heart disease may be difficult as these persons may develop certain symptoms as poor appetite and fatigue which are also symptoms of depression. Careful observation and history taking may be essential to making a diagnosis in such patients. Prescription antidepressant medication particularly the selective serotonin reuptake inhibitors are safe and well tolerated in patients with heart disease. The selective serotonin reuptake inhibitors have a good cardiac profile, and are effective in alleviating symptoms of depression. However, it is important to note that some antidepressant medications raise the level of some cardiac drugs by interfering with their metabolism. Patients taking cardiac drugs and antidepressants should be carefulyl monitored for possible side effects and adverse effects of these medications. Other treatment alternatives include psychotherapy, exercise and social support.