Thursday, September 17, 2015

Depression and Cardiac Events

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."


jaed said...

Ugh. (I've heard this before, though - not about the dysthymia but about the cardiac risk from major depressive episodes. I think Peter Kramer talked about it in his second depression book. Makes holes in one's hypothalamus, too, if I remember correctly.) I'm doomed. Doooooooomed.

SSRIs have been around long enough that I wonder whether there's data on people who take them for decades, and whether it shows a risk reduction for cardiac events and all-cause mortality compared to those with similar diagnoses who take them short-term or not at all.

Also wondering whether taking anti-inflammatory meds helps with this. Maybe people who take aspirin or Advil have been inadvertantly self-treating some of the damage from depression. (Also potentially interesting in light of the medical profession's near-obsession with pushing acetominephan instead of NSAIDs.)

bs king said...

To be fair, acetaminophen has been shown to reduce existential anxiety:

Christopher B said...

Layman's question

All of these drugs have some undesireable side effects. Is the potential life extension really worth long term exposure to these as well?

I don't go to the dr much so I hadn't heard about the preference for acetomrniphine over nsaid. The last thing I was aware of was the liver toxicity of acetaminophen though I've heard some negative comments in long term nsaid use recently.

Anonymous said...

These big names are just side effects of when breathing is out of control. This affects both the neural system and the heart.

Drugs attempt to artificially mitigate or change the consequences of bad breathing cycles, hence the side effects. They don't fix the Original Cause.

lelia said...

This does not surprise me, though it does, heh, depress me. I'm always a little shocked when I see my appearance next to my sister's. She's only a year and a half younger than me, but looks at least a decade, maybe a decade and half younger. Guess which one had always had depression and suffers a mild form of PTSD after raising a violent autistic child? Yep, dooooomed. I do hope taking anti-inflammatories helps, as I'm spending a lot per month on such things in an attempt to live long enough to set up my daughter in a safe situation.