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Pr Charles Nemeroff: Depression is a risk factor for CV diseases

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MD-FM INSIGHT

Depression: a risk factor for cardiovascular diseases

 

 

Clementine:

Hello! You’re on MD-FM INSIGHT, the first medical web radio. Today we’ll be devoting our "Question & Answer" program to the relationship between depression and cardiovascular diseases. Professor Charles Nemeroff, chairman of the department of psychiatry at the University of Miami in Florida, gave a presentation on this topic during the last meeting of the American Psychiatric Association, in San Francisco. Listen to Pr. Nemeroff give us the details of this association: 

 

Clementine:

Pr. Nemeroff, could you please describe this association between depression and cardiovascular risks…

 

Nemeroff-1:

As we all know, coronary artery disease, which results in heart attacks – myocardial infarction –is the number one cause of mortality worldwide. And it turns out that there is an amazing relationship between depression, on the one hand, and heart disease on the other. So depression worsens heart disease in every way: First, it is a risk factor for the development of heart disease. So if someone has had a depression, even ten years ago, they are more likely to develop heart disease later in life. Then, if you have a heart attack, and have a history of depression or are depressed at the time of the heart attack, you are less likely to survive over the next six months than if you were not depressed.”

 

Clementine:

So is it specifically for heart attacks disease?

 

Nemeroff-2:

“So, it turns out that when you study other cardiovascular diseases, such as congestive heart failure, cardiac valve replacement, coronary artery bypass surgery, isolated cystolic hypertension –all of those cardiac diseases actually have a worse outcome and a higher prevalence rate in patients with depression.”

 

Clementine:

Is it possible to give us an idea of the size of the increased risk?

 

Nemeroff-3:

“So, there is a four-fold increase in risk for heart disease in patients with depression. This is a phenomenally large number. It’s really a very big effect. It’s as significant a risk factor for heart disease as cigarette smoking, as elevated plasma cholesterol, as obesity and as family history. So it is one of the biggest of all risk factors.”

 

 

Clementine:

And what’s the evidence to back it up?

 

Nemeroff-4:

So more than 40,000 patients have been in studies to document the increase in heart disease in patients with depression. And we now understand that depression is a disease not only of the brain but of the body.”

 

Clementine:

Do we have any idea of the mechanism at play?

 

Nemeroff-5:

“So there are physiological changes in depression that unfortunately increase the risk for heart disease and it turns out there are probably many factors: increases in stress hormones, increases in the sympathetic nervous system, increases in multiple steps in the platelet clotting cascade, increases in inflammation –all of them conspire to increase this risk. Now the critical question is whether treatment of depression ameliorates this risk, and that has not yet been demonstrated.”

 

Clementine:

Are there studies looking at that?

 

Nemeroff-6:

“Yes there have been a number of small studies that have looked at this, but they’re too small to draw a definitive conclusion. So what we urgently need is a large study to determine once and for all if aggressive treatment of depression, with either psychotherapy or antidepressant medication, can in fact reduce the risk for heart disease in depressed patients.”

 

 

Clementine:

So what are the clinical implications of all this?

 

Nemeroff-7:

Well first, I think, we need to recognize depression because if we recognize it we can treat it and it’s still under-recognized in general medical practice. We have to education cardiologists, because they’re not trained in psychiatry, and they need to be able to detect depression and refer these patients to psychiatrists to treat them. And thirdly we need to aggressively treat the depression because in all likelihood it will reduce the risk for heart disease.”

 

 

Clementine:

This show is over. By visiting the MD-FM website, you can check out the themes of the programs we will be offering you regularly.
See you soon on MD-FM.

 

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