We had Gary Moak speak at Grand Rounds today. He is our new head of Geriatric Psychiatry (most recently at MGH, I think) who has a book coming out in the spring Beat Depression to Stay Healthier and Live Longer, which focuses on older adults. Today's talk looked across the lifespan, noting how episodes of depression in "young people" (17-39) result in 4x greater mortality from cardiac events down the road. I will note that this is after other factors have been equalised.
Higher mortality has usually been explained, or explained away, by people taking less good care of themselves: they eat poorly, they don't take their medicines as diligently, they drink and smoke more, they don't go to the doctor, they have fewer friends and less exercise, all that. Moak is saying that the higher mortality is there even when those factors are accounted for.
I really didn't want to hear that. I asked hopefully at the end if this damage is along a continuum, with severe depression causing more problems, or is it a threshold phenomenon. He answered that dysthymia is probably worse. People who have chronic, low-level depression are much more likely to avoid treatment, tough it out, and repeatedly gird up their loins with some promise to try harder. But depression is a chronic inflammation, a perpetual activation of many body systems, which interrupts natural healing responses just as fully as Major Depression. A half-dozen treated episodes of MDD over 30 years gives the body plenty of time to recover and repair in between. Chronic activation, not so much.
I really didn't want to hear that. I'm pretty much already screwed, then, and playing catch-up. One more big risk factor on board.
Interesting new approach. Depression is being looked at as a sort of accelerated aging - platelets, arteries, telomeres, lots of stuff. Great. Also, the SSRI's have a strong antioxident effect, enough that some stroke centers are prescribing low-dose Prozac to every stroke victim, regardless of whether they have depression or not. Another psychiatrist asked if prophylactic SSRI's might be in the cards for lots of us, and the discussion mostly led to "probably."