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Mental illness and heart disease are often

found in the same patients


Cardiovascular disease and mental illness are among the top contributors to death and disability
in the United States. At first glance, these health conditions seem to lie at opposite ends of the
medical spectrum: Treating the heart is often associated with lab draws, imaging and invasive
procedures, whereas treating the mind conjures up notions of talk therapy and subjective
checklists.

Yet researchers are discovering some surprising ties between cardiac health and mental health.
These connections have profound implications for patient care, and doctors are paying attention.

Depression has become recognized as a major issue for people with heart disease. Studies have
found that between 17 and 44 percent of patients with coronary artery disease also have major
depression. According to the American Heart Association, people hospitalized for a heart attack
are roughly three times as likely as the general population to experience depression. As many as
40 percent of patients undergoing coronary artery bypass surgery suffer from depression.

Decades of research suggest these illnesses may actually cause one another. For example,
patients with heart disease are often sick and under stressful circumstances, which can foster
depressive symptoms. But depression itself is also a risk factor for developing heart disease.
Researchers arent sure why, but something about being depressed possibly a mix of factors
including inflammatory changes and behavior changes appears to increase risk of heart
disease.

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Depressed patients with cardiac disease have mortality rates twice as high as their non-depressed
counterparts. Heart disease patients with depression are at higher risk of cardiac arrest,
complications from surgery and hospital readmission after undergoing procedures than those
without depression.

The issue has become so prominent that the American Heart Association and the American
Psychiatric Association have recommended routine screening of heart disease patients for
depressive symptoms.

And depression isnt the only mental health issue related to heart disease. Researchers are
discovering similar links between cardiovascular disease and other mental health conditions such
as anxiety, bipolar disorder and schizophrenia.
Historically, caring for patients with both heart disease and mental illness has been quite
difficult, as the treatment for one might worsen the other. For example, putting a patient through
the stresses of a cardiac catheterization might worsen anxiety, depression or other psychiatric
symptoms. Beta blockers, a key class of medications used to treat heart disease, were once
thought to cause or worsen depression, though a 2002 review of studies found this claim is not
supported by data from clinical trials. Meanwhile, older psychiatric drugs, such as tricyclic
antidepressants, came with high-risk side effects on the heart.

Today, better awareness of the overlap between heart health and mental health is changing the
treatment of these illnesses. More routine screening for depression and other mental health issues
can help identify cardiac patients in need of collaborative care. Large-scale studies on the
management of these diseases are helping clinicians choose treatments and medications more
wisely.

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New findings point to treatments that can be beneficial for the heart and the mind. Some
evidence suggests newer generations of psychiatric drugs, such as selective serotonin-reuptake
inhibitors, may protect cardiovascular health, and researchers are exploring whether cardiac
medications such as anti-cholesterol statins could be used to treat mood as well. Health-care
providers are also promoting preventive measures, such as exercise and stress management, that
are known to enhance both cardiac health and mental health.

Despite these advances, the comorbidity of heart disease and mental illness continues to affect
patient care every day. For example, as part of my medical training, Ive worked on psychiatric
consultation services in a number of hospitals, evaluating patients on medical or surgical floors
who develop mental health needs. Its not uncommon to be called to cardiac units, where patients
experience distress ranging from depressed mood to acute suicidality.

Ive chatted with patients about the crippling demands that heart transplants or bypass surgeries
place on them. Ive listened as patients struggle to speak, breathing heavily, lungs filled with
fluid from congestive heart failure. Some patients fall into despair after years of endless
medications, hospitalizations and poor health. Others are petrified by the operating room and the
long road to recovery that lies ahead.

Sitting with these patients, I know mental health care can do only so much. Antidepressants
wont unclog their coronary arteries. Talk therapy cant remove that fluid backing up into their
lungs.
But by working together with our colleagues from other specialties, by helping the patient
through the terrifying uncertainties of medicine, I hope we can do some good. A healthy mind
wont ensure a healthy heart. But, indeed, it helps.