Heart disease

The link between depression and heart disease has been studied intensively. Many studies have demonstrated that when patients are depressed and have a heart attack or congestive heart failure, their outcomes tend to be poor compared with those of people who are not depressed. Indeed, depression appears to be an independent risk factor for the development of heart disease. Analysis of data from a large-scale survey revealed that individuals with a history of major depression were more than four times as likely to suffer a heart attack over a 12-to-13-year follow-up period as people without such a history. Even people with a history of 2 or more weeks of mild depression were more than twice as likely to have a heart attack, compared with those who had had no such episodes.

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Of course, depressed individuals are less likely to exercise, eat right, and take their medications. But the connection goes much deeper to the human stress response gone awry. When people are stressed, their blood-clotting system produces extra platelets, sticky cells that help slow down bleeding in the case of a wound. However, when the stress is emotional instead of physical, this response is maladaptive: Both heart attacks and strokes are caused by the formation of clots in the arteries. One study found that depressed patients exhibited increased platelet activation in comparison with normal subjects. Stress also activates cytokines, chemical messengers from the immune system, and elevated cytokine levels can trigger inflammation in the heart.

Both depressed patients and cardiac patients lose flexibility in their heart muscles. A normal heart moves easily between its resting and beating states. But patients with severe coronary artery disease or with depression have more rigid hearts, less able to respond to the changing demands of the body for blood and oxygen.