Depression Makes Heart Patients Feel Worse

It's a better predictor of quality of life than severity of disease, study finds

(HealthDay is the new name for HealthScoutNews.)

TUESDAY, July 8, 2003 (HealthDayNews) -- Cardiac patients who suffer from depression are more likely to feel sick, even when their heart is in better shape than their non-depressed peers.

"Depression nearly doubled the chance of having a worse quality of life," says Dr. Mary A. Whooley, author of a report on the finding, which appears in the July 9 issue of the Journal of the American Medical Association.

In the ongoing study, called the Heart and Soul Study, Whooley and her co-researchers evaluated 1,024 participants with heart disease, 20 percent of whom had symptoms of depression. They used two traditional measures to evaluate heart function, including a test of the heart's pumping strength (left ventricular ejection fraction) and a measure of the blood flow to the heart during exercise (exercise-induced ischemia).

They also asked the participants to rate their overall health, physical limitations, quality of life and symptoms.

Depressed patients were more likely to report lower health status, including more frequent episodes of chest pain, more physical limitations and worse quality of life and overall health, than non-depressed patients. Even when the severity of the disease was taken into account, based on the physical tests, the depressed patients were more likely to have lower quality of life than others.

"I wasn't surprised that depression was associated with a poor quality of life," Whooley says. What did surprise her, she says, is that the two traditional measures of heart functioning weren't associated with how well patients felt or how well they rated their quality of life.

"In clinical practice, I focus on trying to improve the ejection fraction and ischemia," Whooley says. The rationale is that if you fix the physical problems, they will feel better. "In this case, it didn't pan out," she adds.

While 20 percent of the patients in her study were depressed, Whooley says up to 40 percent of heart patients overall may be. In her sample, followed from September 2000 to December 2002, all subjects had a history of heart disease, including attacks, bypass surgery or balloon angioplasty to open up vessels.

"Doctors need to be more aware of depression," she says, "and patients also need to be more comfortable accepting treatment for depression."

Other experts agree more awareness of depression is needed.

"Physicians as a whole are not doing a good job of identifying or treating [depression]," says Robert Maurer, a clinical psychologist at Santa Monica-UCLA Medical Center. "It confirms what we already believed."

Even cardiologists acknowledge doctors need to be more aware of the possibility of depression in their heart patients. "Based on this study, doctors need to learn more about depression and identify these patients early on and then identify safe agents we can used to treat it," says Dr. Ravi Dave, a cardiologist at Santa Monica-UCLA Medical Center.

"I think this study is unique because it shows that depression had more of an effect on the patient's reported overall health status" than did the objective findings of the doctors, Dave adds.

The medical tests to evaluate the heart's physical functioning are important, Dave says. But so is paying attention to the patient's psychological status.

In his own practice, Dave says, he sees the impact of depression. "I have patients with very terrible heart muscle function who go out and climb Mt. Whitney," he says. Yet, he also has some patients with less damage to their hearts who are "very depressed and don't get out of their chairs to do any exercise."

The best advice for a heart disease patient who thinks he or she is depressed, Maurer says, is to "seek a formal evaluation for depression. If your doctor says it's needed, use [antidepressant] medication for six months to a year."

"Depression is a very important aspect [of heart disease] that needs to be recognized and treated," Dave says.

The good news? "Depression is a modifiable risk factor, which is great," he says.

More information

For information about how depression can worsen heart disease, see the National Institute of Mental Health. For information on risk factors and heart disease, see the American Heart Association.

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