It’s been known for a number of years that depression and cardiovascular disease (CVD) have a close relationship—in fact, it’s a two-way street: at least 25 percent of patients with heart disease experience depression, and adults who suffer from depression frequently develop some form of heart disease. According to a report by the National Institutes of Health, “adults with a depressive disorder or symptoms have a 64 percent greater risk of developing coronary artery disease”, which supports evidence collected over a thirty-year period indicating that depression can be a highly significant predictor of heart disease. The report goes on to state that “depressed patients with coronary artery disease are 59 percent more likely to have a future adverse event, such as a heart attack or cardiac death.”
The association between depression and an increased risk for heart disease appears to be independent of whether a person has any other factors that are traditionally considered to be high risk for heart disease, including high cholesterol, hypertension, obesity, diabetes, etc. In fact, researchers have gone so far as to say they are “confident” that depression is an “independent risk factor” for heart disease.
Depression has been determined to be the strongest predictor for death, particularly if it occurs within the first ten years of a heart disease diagnosis; in such cases, the risk of death from depression is double. The findings of an investigation published in JAMA Psychiatry found that “Adults with depressive symptoms experience poor physical health outcomes and increased risk of mortality across the world and in different settings, especially in urban areas.” Research shows that this increased risk of death due to depression transcends age, gender, when depression began, and whether or not the patient had an actual heart attack.
A separate JAMA Psychiatry article reports on several studies showing that “depression and its associated symptoms” are major risk factors for “development of CVD and death” following myocardial infarction. The article goes on to state that when patients with CVD are treated for depression, their longevity, quality of life, and anxiety improve.
Adolescents, Depression, and Heart Disease
But the problem isn’t just limited to adults—in 2015, the American Heart Association issued a statement that “teens with depression and bipolar disorder stand at increased risk for developing cardiovascular disease earlier in life.” The European Society of Cardiology reports that adolescents suffering from depression or anxiety have a 20 percent higher chance of experiencing a mid-life heart attack than those who do not.
It has been noted that mental well-being in young people from childhood up through age 19 is generally declining, making it extremely important that parents and guardians remain vigilant for any signs of depression or anxiety. These can include:
- withdrawal from typical social activities or family
- negative thinking
- eating more or less than normal
- sudden bursts of anger
- unusual irritability
- trouble sleeping or unusual sleep patterns
- headaches and other unexplained pains
- drop in grades
- letting schoolwork slip
- engaging in high-risk behaviors
- excessive worrying
Early diagnosis of depression at any age, along with intervention, is imperative to prevent an escalation to resulting heart disease. Behaviors and lifestyle choices that accompany depression are also linked to the development of heart disease; these include increased use of alcohol, increased smoking, poor dietary choices, lack of exercise, and lack of interest in overall health maintenance.
Chronic mental stress and depression have been shown to negatively impact heart health in multiple studies. Some of the effects include:
- weakened immune system
- arterial damage
- hypertension (high blood pressure)
- irregular heartbeat
- increased post-cardio-surgical pain
- increase in proinflammatory markers
- increased risk of heart attack, blood clots, and CAD
- increased mortality risk
Functional Medicine Takes Aim at the Root Cause
The cycle of chronic depression leading to cardiovascular disease, and, in turn, CVD causing depression, is quite clear. Obviously, the best way to avoid this vicious cycle is prevention; however, once depression has become a recognizable pattern, or heart disease has been diagnosed, a whole person approach aimed at getting to the root cause rather than just treating symptoms is crucial.
For example, conventional medicine doctors typically identify depression using a scoring method and then begin to medicate with antidepressants; there is no test. If sleep has also become a problem for the patient (a common problem associated with depression), sleep medications will most likely be added, and so on. While this mind-numbing and merry-go-round works for some—with varying degrees of success, if any, it is likely to ignore the correctible and reversible symptoms like leaky gut. Plus, the strong possibility of side effects from too many medications can be severe or lead to additional health concerns. This approach doesn’t serve to alleviate the root cause of the problem. In fact, some medications in and of themselves can create higher risk factors for heart disease, autoimmune disease, and many other health issues.
A functional medicine practitioner will look into a wide spectrum of possible causes, from inflammation (gut, body and brain) to toxicity and many others. Changes in lifestyle, dietary habits, stressors and more are all taken into consideration in combination with comprehensive lab tests to uncover the underlying cause of depression, heart disease and other possible previously undiscovered health issues that could be contributing to the patient’s health problems.
Functional medicine will not only look at a patient’s depression and heart disease for their shared trigger, such as blood sugar dysregulation, the practitioner will also look at them in combination–systemically as having the same inflammatory cause. Digging even deeper, the practitioner will search to discover the reason for these elevated inflammation-producing proteins (or other factors) in order to correct the problem at its root. Through these medical investigations, other health issues—either undiagnosed or thus far undetected—can be prevented before they’re able to surface.