Heart Troubles, Depression Often Linked
Some experts say cardiologists don't detect psychological problems
(HealthDay News) -- People with heart disease are much more likely than the general public to suffer from psychological distress, and as many as two in three don't receive treatment for depression and anxiety.
That's especially troubling because people with heart disease and psychological problems have higher death rates than their happier counterparts, Amy Ferketich, an assistant professor of epidemiology and biostatistics at Ohio State University School of Public Health, told HealthDay.
"Patients just aren't being screened," Ferketich said. "The physicians are just focused on the problem at hand, and they're not thinking about all of these other factors that could contribute to the condition." Ferketich authored a study on the issue that was published in the European Heart Journal.
The researchers analyzed data from a U.S. survey of more than 17,000 people with heart disease. Everyone included in the study was older than 40.
The data didn't include rates of depression and anxiety, but the study participants did report symptoms associated with those disorders. So, the researchers sorted through the data to determine if people were suffering from "psychological distress," which includes symptoms such as sadness, nervousness, restlessness, hopelessness and more.
For people with congestive heart failure, the rate of psychological distress was as high as 10 percent, compared with roughly a 3 percent rate for the general population. For heart attack survivors, the rate of psychological distress was about 6 percent.
Yet, only one-third of those experiencing symptoms of psychological distress indicated they'd been treated by a mental-health professional.
According to the National Institute of Mental Health, about one in 20 Americans experiences depression each year. The number jumps to nearly one in three for those who have survived a heart attack.
Symptoms of depression, according to the institute, include:
No interest in once-pleasurable activities, such as hobbies or sex
A persistent sad mood
Feelings of hopelessness or worthlessness
Trouble concentrating or making decisions
Fatigue or a feeling of being slowed down
Unexpected weight changes
Thoughts of suicide
The link between heart attack and depression isn't clear. It's possible that psychological symptoms may cause the heart to beat less effectively, which could contribute to the development of blood clots, said Sylvia Wassertheil-Smoller, a professor of epidemiology and population health at the Albert Einstein School of Medicine in New York City.
However, the study results suggest that cardiologists aren't likely to pick up on patients' psychological symptoms.
"It's a big problem," Wassertheil-Smoller told HealthDay. Cardiologists "don't have time, certainly with managed care and the emphasis on quick turnaround and high productivity in terms of numbers and patients seen. There's not much time for the doctor to be Dr. Welby and find out what's really bothering you."
The good news is that safe and effective treatments are available, even for heart patients. Antidepressant medications generally are safe for people with heart disease, and psychotherapy can be helpful as well. Exercise has been shown to reduce symptoms of depression and improve heart health also. However, people with heart problems should check with their cardiologist before taking any new medications or starting a new exercise program.
On the Web
To learn more about treating depression, visit the Web site of the Depression and Bipolar Support Alliance.
SOURCES: HealthDay News; Amy Ferketich, assistant professor of epidemiology and biostatistics, Ohio State University School of Public Health, Columbus, Ohio; Sylvia Wassertheil-Smoller, Ph.D., professor of epidemiology and population health, Albert Einstein School of Medicine, New York City, June 9, 2005, online edition, European Heart Journal
Author: Serena Gordon
Publication Date: July 31, 2006
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