DEPRESSION AND STRESS CAN LEAD YOUR HEART TO ETERNAL REST

DEPRESSION AND STRESS CAN LEAD YOUR
 HEART TO ETERNAL REST

by Rabia Ahmad (BS Biotechnology) 

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Have you ever thought the most ignorant disorders and the disease states can lead you to the graves? Well, this is somewhat the ignorance is best at. Thinking of the most ignored disorder, one must count depression. People are unaware of this disorder; however, they face it at least once in a lifetime. And, if some people identify it, they are less likely to go for its treatment because this disorder usually doesn’t appear like other diseases. In fact, it is a mental state that doesn’t come up on the stage until it comes out in the worst conditions and worsen the other illnesses like heart diseases.

Once you’re confirmed that the person is in the state of depression and stress, you must know, this can prove lethal especially for the persons who are having coronary heart diseases. So here we go, this article specially focuses on the correlation and the association of depression, stress and anxiety with heart diseases; coronary heart diseases. There is a link between three areas; the neurological pathways, the cardiovascular pathways and the behavioural pathways (Dhar, A. K. and D. A. Barton 2016)

What depression is?

Depression is often confused with stress and anxiety, but actually, they are not the same thing, and it can be the outcome of stress and anxiety. Depression is the feeling of hopelessness and dejection. It causes persistent sadness, and it usually lasts more than usual moods. It can be recognized by symptoms like losing interest in routine life activities, eating more or less than usual, feeling tired and confused all the time.

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What is the rate of depression, globally?

At first, we should be aware of the fact that, according to World Health Organization (WHO), more than 264 million people are suffering from depression per year, globally, according to a survey. About 90% of heart failures are due to hypertension. The rate of depression increases to 15-30% for the people who are having heart disease meaning that heart patients are more prone to depression, and it can prove lethal for their heart health. The subtypes of depression; Bipolar I (intense unusual shifts is mode and energy), Bipolar II (a mild form of bipolar I) and dysthymia (mild but persistent depression) have more severe effects on heart patients. For instance, individuals with dysthymia, irrespective of whether typical or atypical features were present, had significantly elevated levels of interleukins (IL-1β) which are responsible for more inflammation (Baune, Stuart et al. 2012)

What is the science behind depression and coronary heart diseases?

Depression causes the changes in the neurobiology of a person; changes in the central brain areas like the hippocampus, sympathetic nervous system, hormonal pathways and dysregulation of stress response pathways. These all changes collectively then affect the cardiovascular function and structure which leads to heart diseases. And if the person is already suffering from heart diseases it can even worsen the heart problems.

What changes occur neurologically in depression and cardiovascular diseases?

Some brain areas such as hippocampus, amygdala, and cingulate are involved in stress pathways and cardiovascular pathways. The dysregulation of stress response pathways increases the risk of cardiac arrest in vulnerable individuals of coronary heart diseases. The unfavourable changes in the synthesis and activity of neurotransmitters including norepinephrine, serotonin, and dopamine ultimately cause the mood shifts and increase the cardiovascular risk. Apart from that, hormonal imbalance also occurs, such as corticotrophin-releasing factor which is involved in the stress response. It stimulates the synthesis of another stress hormone, adrenocorticotropic hormone. Furthermore, the cortisol hormone levels excessively increase which in turn activates the immune system.

Early signs of cardiovascular disease?

The immune system activates in response to hormones and secretes an excess of cytokines (interleukin 1, interleukin 6) and tumour necrosis factor, which induces inflammation that can lead to atherosclerosis. Prolong depression leads to endothelial dysfunction which is an early sign of cardiovascular disease and results in vasoconstriction. Platelet count also increases which form a thrombus formation and ultimately can cause myocardial ischemia (restriction in blood supply).

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Untreated depression vs cardiovascular disease

People don’t usually notice but they experience myocardial ischemia (restriction in blood supply) on a daily basis due to sympathetic nervous system during emotional stress especially in women. The imbalance between sympathetic and parasympathetic nervous system can even lead to sudden cardiac death.

Human behaviours have also played a crucial role in depression and heart diseases. People may experience depression due to the lack of activities and sitting always in the corner. Lack of activity and exercise can lead to depression and obesity. Obesity can induce various metabolic syndromes including cardiovascular diseases. The patients with type II diabetes have 40% increased risk of developing cardiovascular diabetes and depression.

Are there any gender differences?

The prevalence of clinically significant depression (Patient Healthcare Questionnaire-9 > 9) among hospitalized patients with the cardiac disease was 40.0%. However, the prevalence of non-minimal depression (PHQ-9 ≥ 5) in this study was 78.4%. It was greater among women (83.1%) than among men (72.9%) (Bahall 2019). The rate of depression is higher in women as compared to men. But after myocardial infarction (MI) risk is similar for both genders.

How can we recognize and screen depression?

Depression is common in today’s population, but it is often unrecognized and untreated due to ignorance. For the assessment of depression, Structured and Clinical Interview for the DSM-5 (SCID) is taken in which the score, according to the Hamilton Depression Scale, if greater than 9 shows moderate to severe depression. Various factors can act as barriers in the recognition and screening of depression which includes:

·         Lack of counselling

·         Support for self-care

·         Lack of a better quality of life (smoking, alcoholism).

For heart patients, it further includes:

·         Lack of training in cardiology centres

·         Lack of mental health expertise

What are the treatments of depression and how can we manage it?

To decreases the risk of cardiovascular diseases, improvement in reducing depression can be achieved by:

·         Cardiac rehabilitation

·         Improving the quality of life

·         Exercise / Yoga / Meditation

·         Mindfulness activities

·         Anti-depressants

Ø  Tricyclic antidepressants

Ø  Serotonin reuptake inhibitors (fluvoxamine, sertraline)  

·         Electroconvulsive therapy (last solution with 80% response rate)

Conclusion

In a nutshell, depression is not only life-threatening to the patients who are already having coronary heart diseases, but it is also lethal to healthy people who may develop heart diseases. A huge population faces depression and ignore it, but physiologically it’s catastrophic to their mental as well as to their physical health. Especially the heart patients are in much risk of cardiac arrest and ultimately death. The young generation, nowadays, experiencing it on a daily basis but they are ignoring its symptoms and don’t go for treatment and support, which may cause adverse effects on their health in near future.

Future recommendation

A lot of awareness is needed regarding depression, its recognition and treatment. To overcome depression, psychiatrists and psychologist should come forward and provide awareness and give people motivation, hope and courage to face the challenges of life.

Author’s inspiration

Rabia Ahmad (BS Biotechnology) has written this article. She was inspired motivated by her mentor Miss Iqra Aslam (MPhil Biochemistry), Lecturer of Biochemistry at University of Management and Technology, Sialkot, Punjab, Pakistan.

Reviewer and editor information

Muhammad Numan (PhD Scholar Biochemistry) and Miss Iqra Aslam (MPhil Biochemistry) have reviewed and edited this article.

References

Dhar, A. K. and D. A. Barton (2016). "Depression and the Link with Cardiovascular Disease." Front Psychiatry 7: 33.

Bahall, M. (2019). "Prevalence and associations of depression among patients with cardiac diseases in a public health institute in Trinidad and Tobago." BMC Psychiatry 19(1): 4.

Baune, B. T., et al. (2012). "The relationship between subtypes of depression and cardiovascular disease: a systematic review of biological models." Transl Psychiatry 2: e92.

Huffman, J. C., et al. (2013). "Depression and cardiac disease: epidemiology, mechanisms, and diagnosis." Cardiovasc Psychiatry Neurol 2013: 695925.

Vaccarino, V., et al. (2020). "Depression and coronary heart disease: 2018 position paper of the ESC working group on coronary pathophysiology and microcirculation." Eur Heart J 41(17): 1687-1696.