Cardiovascular disease is the number one killer in America. It kills more people each year than cancer. Depression, an underrecognized and undertreated disease in the medical population, may be contributing to this worrisome public health threat. 

Origins of The Idea
In 1628 William Harvey, an English physician, defined the circulatory system as we know it and proposed a link between the heart and the mind as it pertains to health. This phenomenon went ignored for centuries and was not investigated. Now, research is providing a comprehensive look at the interconnectedness of physical and mental health. 

Chicken or the Egg  
Which came first? Depression or cardiovascular disease? The answer is both. The Journal of the American Medical Association has recorded studies that purport major depression disorder as a risk factor for the development of incident coronary heart disease events in healthy patients and for adverse cardiovascular outcomes in patients with established heart disease. In fact, one in five patients with coronary heart disease and one in three patients with congestive heart failure were found to have suffered from depression prior to diagnosis. Being depressed prior to diagnosis puts you at a greater risk and becoming depressed after diagnosis puts you at a greater risk for an unfavorable outcome. The question remains...why? 

Depression, according to the National Institute of Mental Health, is beyond just a fleeting feeling of sadness. Rather it occurs when a person's life is disrupted by a persistent despondency that interferes with daily activities and normal functioning. Symptoms include:

  • Persistent sad, anxious or "empty" feelings
  • Feelings of hopelessness and/or pessimism
  • Feelings of guilt, worthlessness and/or helplessness
  • Irritability, restlessness
  • Loss of interest in activities or hobbies once pleasurable, including sex
  • Fatigue and decreased energy
  • Difficulty concentrating, remembering details and making decisions
  • Insomnia, early-morning wakefulness, or excessive sleeping
  • Overeating, or appetite loss
  • Thoughts of suicide, suicide attempts
  • Persistent aches or pains, headaches, cramps or digestive problems that do not ease even with treatment

If you look at the list above you can see that some of these symptoms have clear physical implications. Beyond that, patients with depression are in a contact state of perceived stress. Compared with what the American Heart Association lists as major risk factors, the lists look strikingly similar. Stress, obesity, and physical inactivity are among the top risk factors for cardiovascular disease. In severe cases, depression can be debilitating, impeding your ability to get out and get exercise, eat healthy, or do something that makes you happy. Treatment is available for this, although the National Institute of Mental Health reports that most adults will not seek treatment.

The same goes for people who already have heart disease and are suffering from depression. Both the American Heart Association and the American College of Cardiology have found that compared with non-depressed patients, those that are depressed are significantly less likely to adhere to prescribed medications, follow lifestyle recommendations, practice self-management, or even receive cardiac testing. 

Depression not only puts you at a great risk for developing cardiovascular disease, it also serves as a barrier between you and recovery from cardiovascular disease. Talk to your healthcare team if you don't feel like taking care of yourself. You might be suffering from one of many depressive disorders that can get in the way of a long and fulfilling life.