2006 Heart-Brain summit proceedings
Depression and heart disease
ARTICLE INTRODUCTION
Considerable evidence strongly supports an association between depression and cardiac disease: depression (both major depressive disorder and depressive symptoms) is a predictor of short-term and long-term mortality in patients following myocardial infarction (MI) and is also a predictor of having an acute coronary event in the general population.
The nature of the association has been contested. Does depression cause heart disease because of behavioral factors, autonomic dysfunction, or enhanced inflammation? Or does another factor—such as dietary intake of foods rich in omega-3 fatty acids—simultaneously affect both depression and heart disease? Evidence supports each theory.
Despite the well-proven association between heart disease and depression, attempts thus far to target depression to improve heart disease outcomes have been unsuccessful.
This article reviews the strength of the epidemiologic data linking depression and heart disease and discusses possible mechanisms to explain this relationship.
CITATIONS
- Frasure-Smith N, Lespérance F, Talajic M.
Depression following myocardial infarction. Impact on 6-month survival. JAMA 1993; 270:1819–1825. Erratum in: JAMA 1994; 271:1082.
http://www.ncbi.nlm.nih.gov/pubmed/8411525 - Lespérance F, Frasure-Smith N, Talajic M, Bourassa MG.
Fiveyear risk of cardiac mortality in relation to initial severity and oneyear changes in depression symptoms after myocardial infarction. Circulation 2002; 105:1049–1053.
http://www.ncbi.nlm.nih.gov/pubmed/11877353 - Welin C, Lappas G, Wilhelmsen L.
Independent importance of psychosocial factors for prognosis after myocardial infarction. J Intern Med 2000; 247:629–639.
http://www.ncbi.nlm.nih.gov/pubmed/10886484 - Rugulies R.
Depression as a predictor for coronary heart disease. A review and meta-analysis. Am J Prev Med 2002; 23:51–61.
http://www.ncbi.nlm.nih.gov/pubmed/12093424 - Carney RM, Blumenthal JA, Stein PK, et al.
Depression, heart rate variability, and acute myocardial infarction. Circulation 2001; 104:2024–2028.
http://www.ncbi.nlm.nih.gov/pubmed/11673340 - Maier SF, Watkins LR.
Cytokines for psychologists: implications of bidirectional immune-to-brain communication for understanding behavior, mood, and cognition. Psychol Rev 1998; 105:83–107.
http://www.ncbi.nlm.nih.gov/pubmed/9450372 - Wann BP, Boucher M, Kaloustian S, Nim S, Godbout R, Rousseau G.
Apoptosis detected in the amygdala following myocardial infarction in the rat. Biol Psychiatry 2006; 59:430–433.
http://www.ncbi.nlm.nih.gov/pubmed/16202395 - Wann BP, Madjou Bah T, Boucher M, et al.
Vulnerability for apoptosis in the limbic system following myocardial infarction in the rat: a possible model for human post-infarct major depression. J Psychiatry Neurosci 2006. In press. *Same Journal, different date*
http://www.ncbi.nlm.nih.gov/pubmed/17245469 - Tyring S, Gottlieb A, Papp K, et al.
Etanercept and clinical outcomes, fatigue, and depression in psoriasis: double-blind placebocontrolled randomised phase III trial. Lancet 2006; 367:29–35.
http://www.ncbi.nlm.nih.gov/pubmed/16399150 - Frasure-Smith N, Lespérance F, Irwin MR, Sauvé C, Lespérance J, Théroux P.
Depression, C-reactive protein and two-year major adverse cardiac events in men after acute coronary syndromes. Biol Psychiatry 2006. In press. *Same Journal, different date*
http://www.ncbi.nlm.nih.gov/pubmed/17210140 - Kraemer HC, Lowe KK, Kupfer DJ.
To Your Health. New York, NY: Oxford University Press; 2005. - Penninx BW, Kritchevsky SB, Yaffe K, et al.
Inflammatory markers and depressed mood in older persons: results from the Health, Aging and Body Composition study. Biol Psychiatry 2003; 54:566–572.
http://www.ncbi.nlm.nih.gov/pubmed/12946885 - Haag M.
Essential fatty acids and the brain. Can J Psychiatry 2003; 48:195–203.
http://www.ncbi.nlm.nih.gov/pubmed/12728744 - Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto miocardico.
Dietary supplementation with n-3 polyunsaturated fatty
acids and vitamin E after myocardial infarction: results of the
GISSI-Prevenzione trial. Lancet 1999; 354:447–455. Erratum in:
Lancet 2001; 357:642.
http://www.ncbi.nlm.nih.gov/pubmed/10465168 - Hibbeln JR.
Fish consumption and major depression. Lancet 1998; 351:1213.
http://www.ncbi.nlm.nih.gov/pubmed/9643729 - Hibbeln JR.
Seafood consumption, the DHA content of mothers’ milk and prevalence rates of postpartum depression: a cross-national, ecological analysis. J Affect Disord 2002; 69:15–29.
http://www.ncbi.nlm.nih.gov/pubmed/12103448 - De Vriese SR, Christophe AB, Maes M.
Lowered serum n-3 polyunsaturated fatty acid (PUFA) levels predict the occurrence of postpartum depression: further evidence that lowered n-PUFAs are related to major depression. Life Sci 2003; 73:3181–3187.
http://www.ncbi.nlm.nih.gov/pubmed/14561523 - Noaghiul S, Hibbeln JR.
Cross-national comparisons of seafood consumption and rates of bipolar disorders. Am J Psychiatry 2003; 160:2222–2227.
http://www.ncbi.nlm.nih.gov/pubmed/14638594 - Frasure-Smith N, Lespérance F, Julien P.
Major depression is associated with lower omega-3 fatty acid levels in patients with recent acute coronary syndromes. Biol Psychiatry 2004; 55:891–896.
http://www.ncbi.nlm.nih.gov/pubmed/15110732 - The ENRICHD investigators.
Enhancing recovery in coronary heart disease patients (ENRICHD): study design and methods. Am Heart J 2000; 139(1 Pt 1):1–9.
http://www.ncbi.nlm.nih.gov/pubmed/10618555 - ENRICHD Investigators.
Effects of treating depression and low perceived social support on clinical events after myocardial infarction. JAMA 2003; 289:3106–3116.
http://www.ncbi.nlm.nih.gov/pubmed/12813116 - Glassman AH, O’Connor CM, Califf RM, et al.
Sertraline treatment of major depression in patients with acute MI or unstable angina. JAMA 2002; 288:701–709. Erratum in: JAMA 2002; 288:1720.
http://www.ncbi.nlm.nih.gov/pubmed/12169073 - Frasure-Smith N, Koszycki D, Swenson JR, et al.
Design and rationale for a randomized, controlled trial of interpersonal psychotherapy and citalopram for depression in coronary artery disease (CREATE). Psychosom Med 2006; 68:87–93.
http://www.ncbi.nlm.nih.gov/pubmed/16449416