Cardiovascular disease is the leading cause of death in women, yet only one in five is aware of the health threat. And the staggering mortality rate can be attributed in part to lack of awareness of lesser-known CVD symptoms like depression.
Mental health disorders like depression and anxiety are associated with an increase in heart rate and blood pressure, reduced blood flow to the heart, and heightened levels of cortisol. Over time, these effects can lead to calcium buildup in the arteries, metabolic syndrome and heart disease.
“What we can say with certainty is that depression and heart disease often occur together,” said Dr. Roy Ziegelstein, MD, vice dean for education at Johns Hopkins University School of Medicine. “About one in five who have a heart attack have depression and it’s prevalent in women with heart failure. Women with or without CVD also experience depression at higher rates than men.”
In fact, the American Heart Association notes that heart patients are three times as likely to experience depression compared to the general population.
Heart patients are three times as likely to experience depression compared to the general population.
Despite the proven link between depression and cardiovascular disease, many women remain unaware—likely due to an underrepresentation of women in research studies, a lack of widespread use of depression screening tools, and the nature of mental health symptoms and their impact on patient and caregiver ability to relate depression symptoms to CVD.
To help improve health outcomes, experts agree on the need for wider use of depression screening tools in primary care, cardiology and other clinical settings and increased promotion of depression education and treatment programs.
A complicated relationship
The depression and CVD relationship creates a vicious cycle: People with CVD are at greater risk for depression or anxiety, which can in turn increase the risk for another cardiac event. And it’s a two-way street, Ziegelstein said.
“Those with depression but no previously detected heart disease seem to develop heart disease at a higher rate than the general population. But it’s somewhat difficult to prove that heart disease leads to the development of a first-ever episode of depression—this is because people with previous episodes of depression may not have had a diagnosis until they see a doctor for heart problems.”
The first step to reduce the chance of developing depression after a CVD diagnosis or cardiac event (and decrease the risk of developing CVD) is creating an awareness of depression symptoms.
Recognizing depression symptoms
Heart disease and depression both share symptoms such as fatigue, low energy, and difficulty sleeping and managing daily activities. Women recovering from a cardiac event (or those helping to manage a loved one’s chronic CVD) should be on the alert for these and other depression symptoms. If they remain persistent, consider professional intervention.
Without specific screening, however, patients, family members, caregivers and cardiologists may attribute depression symptoms to the CVD. Mental health symptoms also affect a person’s ability to participate in secondary prevention such as medication adherence and cardiac rehabilitation.
Sometimes, underlying and untreated depression can be made worse by medications, a physical disorder, virus or illness, so medical providers may perform a physical exam or order laboratory tests. They may also evaluate family medical history and any history of drug or alcohol use.
To make a diagnosis, a health care provider may ask for a detailed description of physical and emotional symptoms. Patients recovering from an illness, hospitalization or surgical procedure often experience common symptoms like fatigue and insomnia, but other symptoms include withdrawal from activities, lack of reactivity from visits with family and friends, increased negative thoughts, or tearfulness.
Although there are no specific blood tests used to diagnose depression, there are various clinical screening tools used to assist in making a proper diagnosis.
It’s worth noting that while the AHA recommends heart patients be routinely screened and treated, less than 50% of cardiologists reported treating depression—emphasizing the importance of caregivers serving as an advocate for their loved ones.
The U.S. Preventive Services Task Force recommends that consulting clinicians ask two initial screening questions for depression, known as the Patient Health Questionnaire (PHQ-2). Health care providers can also administer the Patient Health Questionnaire 9 (PHQ-9), a nine-item question list that better defines depression and guides treatment recommendations.
The Annual Medicare Wellness Visit also covers screenings for cardiology, depression and behavioral cardiology. While screenings are covered under Part B, referrals to treatment specialists may or may not be covered.
And the Geriatric Depression Screening is another clinical tool designed for assessing depression symptoms in older people. It’s ideal for evaluating the clinical severity of depression and assessing possible courses of treatment.
Technology holds promise in treating CVD-related depression
Researchers are optimistic about the promise of technology in improving depression management in heart failure by using existing technology:
- Mobile applications: Track depressive behaviors (altered activity, sleep, mood)
- Use of social networks: Facebook’s suicide prevention tool, for example, or support groups
- Portable devices: Early symptom detection and monitoring
- Data analysis: Use of electronic health records to achieve optimal health outcomes
- Telemedicine: Reduce travel burden and stress on higher-risk patients for screening, monitoring and tracking health progress
Depression and CVD prevention efforts have helped to establish centers dedicated to women’s health. The National Institutes of Health has identified 20 Centers of Excellence in Women’s Health and dozens of other specialized centers around the country have been created to help women with heart disease.