A Troubled Heart

Connect the dots between depression and heart disease.

You won't see a dotted line on an anatomy chart, but the connection is increasingly clear: There's a strong link between the brain and the heart, between depression and heart disease. Depression affects about one in five heart attack survivors and slows their recovery. That compares to about one in 20 American adults who experiences major depression in a given year.

While doctors have known about this link for more than 15 years, more recently researchers have shown that depression is a significant risk factor for heart disease.

The latter connection should be of special concern to women, says Sharonne Hayes, M.D., cardiologist at Mayo Clinic in Rochester, Minn. Overall, women's rate of depression is two times greater than the rate in men. Consider this: A recent study of postmenopausal women with no history of heart disease found that women with depression had a 50 percent greater risk of developing or dying of heart disease.

"It's not simply a cause-and-effect relationship, but the two conditions are definitely related," Dr. Hayes says. "If you have depression, you are at higher risk of heart disease." Heart disease is the leading killer of women and men.

While depression is typically considered a brain disorder, the possible repercussions from the disease read like a checklist for heart disease:

• Depression may cause abnormal heart rhythms, increased blood pressure and faster blood clotting.
• Depression can elevate cholesterol levels.
• Depression may result in chronically elevated levels of stress hormones, which can contribute to heart damage.
• Depression can elevate insulin levels.
• Add to that list the hopelessness that surrounds depression. "People aren't likely to eat right, take medications or exercise," Dr. Hayes says.

Check for these symptoms if you think you may be depressed. Talk to your doctor if at least five of these symptoms are present for two weeks:

• Persistent sadness or anxiousness
• Loss of interest in normal activities
• Feelings of guilt, worthlessness or helplessness
• Restlessness and irritability
• Decreased energy
• Difficulty concentrating
• Sleep disturbances (insomnia or oversleeping)
• Appetite or weight changes
• Thoughts of death or suicide

The complex interplay between depression and heart disease may allow for one or both to go undiagnosed. Given the impact depression can have on the development of heart disease or recovery from a heart attack, prompt evaluation and treatment are important.