Can depression lead to heart disease?

Yes, says Lawson Wulsin, M.D., professor of psychiatry and family medicine at the University of Cincinnati and author of Treating the Aching Heart: A Guide to Depression, Stress, and Heart Disease. Both diseases are very common: One in five Americans will experience a major depressive episode and one in three will die from heart disease. “Troubles with the mind, such as depression, contribute over many years to troubles with the body, such as coronary disease, sometimes with devastating but preventable results."

How can depression lead to heart disease?

In many ways, says Dr. Wulsin: “Persistent depression harms the body: It disrupts your stress response system, contributes to autonomic imbalance, and increases blood clotting. All of those in a direct way contribute to heart disease. Depression also worsens four of the six major risk factors for heart disease: smoking, diabetes, lack of physical activity and obesity. If you’re depressed, you may exercise less, eat unhealthy foods, experience disrupted sleep and/or smoke. Those behaviors, in turn, add to your risks for obesity and diabetes. Over time, those processes can lead to heart disease.” 

Can heart disease contribute to depression?

“The relationship between heart disease and depression is a vicious cycle,” says Dr. Wulsin. “The most likely mechanism by which heart disease leads to depression is changes in blood flow to the heart and brain. ‘Vascular depression’ is the current working hypothesis. People who have never had a depressive episode before will suddenly experience one following a stressful cardiac event, such as chest pain, a heart attack or bypass surgery. About forty percent of people who have had bypass surgery develop major or minor depression.”

How can my doctor help me relieve depression and heart disease?

Fewer than half of all patients with depression and heart disease get effective treatment for the depression, notes Dr. Wulsin. Raising the issue with your doctor can benefit you; your primary-care physician is the best person to coordinate mental-health care and care of heart disease.

“A good doctor is going to figure out if there’s a strong family history of either depression or heart disease, and also learn how many episodes of depression you have had and how severe they were,” he says. “The doctor will also take your blood pressure and may conduct tests for heart disease risks, such as a lipid profile, a C-reactive protein test and/or an EKG.”

There are effective treatments for both depression and heart disease, Dr. Wulsin points out, but you have to get the right diagnosis in the first place to get the help you need. Depression can be effectively treated with psychotherapy, especially cognitive therapy or interpersonal therapy. Medications such as antidepressants can also be effective. Your doctor may suggest one method or a combination of methods.

Controlling heart disease risk factors, such as high cholesterol or high blood pressure—through diet and exercise programs, as well as with medication—is the key to preventing heart disease, he notes. The good news is that treating depression well may help protect the heart, and treating the heart well may help protect against depression. 

Lawson Wulsin, M.D., professor of psychiatry and family medicine at the University of Cincinnati