What can help with depression and coronary artery disease?

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Many people who have coronary artery disease (CAD) also develop depression. Depression can also make heart problems worse. Psychological treatment and medication can relieve depression that follows stressful events like a heart attack or bypass surgery.

Coronary artery disease (CAD) is caused by a narrowing of the blood vessels that supply the muscles of the heart (coronary arteries). This means that the heart doesn't get enough oxygen because the blood vessels allow less blood to flow through. Coronary artery disease can lead to typical chest pain, a heart attack, heart failure and an irregular heartbeat. Many people who have coronary artery disease also develop depression.

Heart disease can cause depression

Depression that is linked to coronary artery disease is most common after serious events, for example following a heart attack.  Research has shown that about one in five people who have inpatient treatment for a heart attack will develop depression requiring treatment afterwards. Many more will have milder symptoms of depression following a heart attack. The majority of people who develop symptoms of depression after a heart attack are likely to remain depressed for one to four months after leaving the hospital. Sometimes depression that requires treatment will still affect the person's emotional and physical wellbeing five years after the heart attack.

Depression increases the risk of heart problems

So heart attacks and similar health problems increase the chances of developing depression. On the other hand, long-lasting depression can also increase the likelihood of heart disease: It slows recovery and can increase the overall risk of becoming sick and dying. There are a number of different biological mechanisms that experts think might lead to depression affecting the heart. But specific behavioral habits that are more common in people with depression might also play a role, such as smoking or not getting enough exercise.

Research on psychological treatments and medications

The psychotherapeutic and psychological treatment options for depression include cognitive behavioral therapy, psychoanalysis and interpersonal psychotherapy, as well as support services and counseling. Medications known as antidepressants are also available.

Researchers from the Cochrane Collaboration – an international research network – looked into the issue of how to reduce depression in people with coronary artery disease. They looked for studies testing the benefits of psychological treatments and medications. They found seven studies on psychological support and eight on treatment with medication. A total of about 4,000 people participated in these studies. All participants had serious heart problems: Most of them had recently had a heart attack or bypass surgery. Some people who had episodes of chest pain (angina pectoris) were also included.

The benefits of psychological treatments

Research has shown the following: Psychological support and treatment can relieve depression in people with coronary artery disease. It improved symptoms in stressful situations, such as after a heart attack or bypass surgery. In one small study these interventions were also found to improve quality of life. The treatments studied included cognitive behavioral therapy, stress management and interpersonal psychotherapy (a form of short-term psychotherapy commonly used for treating depression). Only one larger study looked at how psychological treatment affects the risk of heart disease over the long term. That study showed that the treatment didn't reduce the risk of a heart attack or death. Based on the available research results, it is not yet possible to say whether one specific form of psychological treatment or support is especially effective.

Benefits of medication

Antidepressants were also found to reduce depression in people with coronary artery disease. Taking these medications led to fewer hospital stays too. But taking medication didn't lower the risk of heart disease. It's also not clear how medication affects quality of life.

Most of the studies tested one group of antidepressants known as selective serotonin reuptake inhibitors (SSRIs). While SSRIs are suitable for people with heart problems, other antidepressants such as tricyclic antidepressants and monoamine oxidase inhibitors (MAOI) are not.

Both treatments have limited benefits

Although the treatments were effective, the overall benefit of both psychological treatment and medication was limited. There are various possible explanations for this: The treatments may have helped such a small number of people that the effect seems small overall. Or they only slightly relieved the symptoms – in very severe depression, for example. Another possibility might be that depression improved in many people without any treatment.

Even if there's no clear improvement over a longer time period despite treatment, there's no need to feel discouraged. People with depression need reliable support, and it can sometimes take a while for the situation to improve.