A little-known link: depression and heart disease

[Guest guest]

the most interesting

finding was the fact that the death rate from heart-related problems was 20

percent lower among patients taking the drug.

Well, what DID they die of -- suicide????? Clever wording, what! And not too long ago there was a study that showed that mild depression was GOOD for you! D'oh! Who can keep up with the ever-shifting sands of opinion sponsored by Big Pharma.

Blind Reason

a novel of espionage and pharmaceutical intrigue

Think your antidepressant is safe? Think again.

[Guest guest]

One of the first attempts at damage control from most recent bad publicity

regarding antidepressants. You'll see more of these types of articles in

the coming days.--

A little-known link: depression and heart disease

By TARA PARKER-POPE

The Associated Press

2/23/04 10:42 AM

The Wall Street Journal

You may have one of the biggest risk factors for heart attack, and your

doctor doesn't even know it.

While doctors screening for heart problems know to monitor smoking, high

cholesterol and high blood pressure, few doctors pay attention to a

potentially more serious foe: depression.

Though depression doesn't sound like something that would affect your heart

health, many studies around the world show that it clearly does. Otherwise

healthy patients with symptoms of depression have been shown to have as much

as a 70 percent higher risk of having a heart attack -- making depression

almost as serious a risk factor as smoking. And depression can increase the

chance of dying in the months after a heart attack by as much as 3.5 times.

Earlier this month, more evidence about the link between depression and

heart attack came from the Women's Health Initiative, the largest ever study

of postmenopausal women. Among the more than 93,000 women studied, women who

were depressed had a 50 percent greater risk of developing or dying from

cardiovascular disease than women who didn't show signs of depression.

The study showed that even among healthy women with no prior history of

heart problems, depression proved to be a significant risk factor for

developing heart problems and later dying from them. It's important to note

that women with severe depression or other forms of mental illness weren't

included in the study, and the women at risk often had only mild or moderate

symptoms of depression.

The results from the Women's Health Initiative bolster the link between

depression and heart disease, but for a variety of reasons, very little is

being done about it.

The biggest problem is that no study has shown conclusively that treating

depression, with either therapy or antidepressant drugs, makes a difference

in heart health. In a study of nearly 2,500 heart-attack patients, published

in the Journal of the American Medical Association in June, behavioral

therapy to treat depression didn't change survival rates compared with

patients who received regular care.

But despite the disappointing results, the study, known as the Enhancing

Recovery in Coronary Heart Disease Patients, or Enrichd, did produce an

intriguing finding. About 20 percent of patients in the study ended up on

antidepressants, either because they weren't responding to therapy or

because they were in the control group and needed to be treated for severe

depression. Among those patients, the risk of dying or suffering a second

nonfatal heart attack was 42 percent lower.

A separate study of the antidepressant sertraline (sold under the brand name

Zoloft) was designed to test whether the drug was safe to use in heart

patients. While the study, called Sadheart (Sertraline Antidepressant Heart

Attack Randomized Trial), showed the drug to be safe, the most interesting

finding was the fact that the death rate from heart-related problems was 20

percent lower among patients taking the drug.

Neither study, however, proves that drug therapy can make a difference for

heart patients. In the Enrichd study, patients weren't randomly given the

drugs, so those data aren't reliable. The Sadheart study wasn't designed to

assess whether the drugs worked -- only that they were safe. There simply

weren't enough people studied to make the lower-death-rate trend

statistically significant.

The simple answer would be to drum up another study big enough to show

whether antidepressant treatment can make a difference for heart patients.

But Zoloft and many of the big antidepressants are soon losing patent

protection -- meaning drug companies have no financial incentive to pony up

the funds for a heart study.

And while new antidepressants are being introduced, a heart study is low on

the list of priorities. That's because depression in heart patients tends to

be mild or moderate -- and the placebo effect makes it tough to show an

antidepressant makes a difference. What's more, because heart patients

typically take a number of drugs, doctors are wary of prescribing new

antidepressants that haven't yet been proved safe for heart patients.

The other problem is that the issue cuts across two disciplines -- cardiac

care and psychiatry -- making it tough to win support for the issue.

Cardiologists typically aren't interested in depression, and psychiatrists

don't usually think about heart disease and diabetes. Big-money groups, such

as the American Heart Association or the National Institutes of Health, have

yet to make depression and heart disease a significant budget priority,

focusing instead on other heart issues.

" In cardiology there have been dozens of studies done on hypertension, " says

Freedland, professor of psychiatry at Washington University School

of Medicine in St. Louis, who has been studying the link between depression

and heart disease since the 1980s. " We need to make sure the public and

medical community understand that this is an important problem, too. "

The problem is most apparent when a patient seeks care. Cardiologists and

family-practice doctors often don't screen for depression, and psychiatrists

are rarely called in to assess patients with heart disease.

" If there were a large 4,000-patient study, it would change how

cardiologists, internists and general practitioners looked at depression, "

says Glassman, professor of psychiatry at Columbia University

College of Physicians and Surgeons and lead author of the Sadheart study.

" They'd have new respect for it. "

So, what should patients do? The first step is to take depression seriously.

During your next physical, talk to the doctor about depression just as you

would discuss other general health issues. Depression poses the highest risk

to patients with known heart disease or a history of heart attack, so they

or their family members should pay particular attention to symptoms. Most

doctors are aware of simple questions that can easily screen for symptoms of

depression, which include a persistent sad, anxious or empty mood; loss of

interest in hobbies, sex or other pleasurable activities; insomnia; fatigue;

and appetite change.

Women should also be aware of the risk, because their symptoms may easily be

dismissed as emotional fluctuations triggered by menopause. " Doctors need to

pay attention to it and consider it as another risk factor for heart disease

just like high cholesterol -- and not write it off as a complaint of

postmenopausal women, " says Sylvia Wassertheil-Smoller, professor of

epidemiology and population health at Albert Einstein College of Medicine in

New York and lead author of the Women's Health Initiative depression study.

And finally, even though there's no proof yet that treating depression will

make a difference in heart health, that's not an excuse to ignore it.

" There are other reasons to treat depression, " says Pickering,

director of Columbia University Medical Center's Behavioral Cardiovascular

Health and Hypertension Program. " You should treat it because people feel

better and function better. "