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Researchers Link Depression and Heart Disease

Loyola psychiatrist suggests new subspecialty, ‘psychocardiology’ (Feb. 18)

A psychiatrist at Loyola University Medical Center has proposed a new subspecialty — “psychocardiology” — to diagnose and treat patients with both depression and heart disease.

In a recent study, Angelos Halaris, MD, PhD, and his colleagues found that an inflammatory biomarker — interleukin-6 (IL-6) — was significantly higher in the blood of 48 patients diagnosed with major depression than it was in 20 healthy controls. IL-6 has been associated with cardiovascular disease.

Halaris presented his findings at a joint congress of the World Psychiatric Association and the International Neuropsychiatric Association in Athens, Greece.

Forty percent to 60% of patients with heart disease also have clinical depression, and 30% to 50% of patients with clinical depression are at risk of developing cardiovascular disease, Halaris said.

Stress is the key to understanding the association between depression and heart disease, according to Halaris. Stress can lead to depression, and depression, in turn, can become stressful.

The body’s immune system fights stress as it would fight a disease or infection, Halaris said. In response to stress, the immune system produces proteins called cytokines, which include IL-6. Initially, this inflammatory response protects against stress; but over time, a chronic inflammatory response can lead to arteriosclerosis and cardiovascular disease.

It’s a vicious cycle: depression triggers chronic inflammation, which leads to heart disease, which causes depression, which leads to more heart disease.

Clinical depression typically begins in young adults. “Treating depression expertly and vigorously in young age can help prevent cardiovascular disease later on,” Halaris said.

Physicians often work in isolation, with psychiatrists treating depression and cardiologists treating cardiovascular disease. Halaris proposes that psychiatrists and cardiologists work together in a multidisciplinary subspecialty, which he calls “psychocardiology.”

Such a subspecialty, he says, would allow earlier detection of cardiovascular disease risk in psychiatric patients and psychiatric problems in heart disease patients, and it would provide continuing education to physicians in the appropriate use of medications in cardiac patients who have psychiatric disorders.

“It is only through the cohesive interaction of such multidisciplinary teams that we can succeed in unraveling the complex relationships among mental stress, inflammation, immune responses and depression, cardiovascular disease, and stroke,” Halaris said.

Source: Loyola University; February 18, 2013.

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