Up Out of the Dumps
Depression can be a killer… literally. A new study reveals that beyond having profound effects on quality of life, depression may be associated with premature death due to heart disease among postmenopausal women. But the study also indicates that the solution to this problem cannot be found through a standard treatment of antidepressant drugs.
Previous studies have already linked depression to increased risk of heart disease. In the e-Alert "Back on Track" (11/4/03), I told you about a six-year study of more than 4,000 subjects that showed a clear association between elderly depression and an elevated risk of coronary heart disease. Researchers don't believe that depression actually causes heart disease, but the association is strong enough that they feel depression should be regarded as one of the early warning signs. In a study just published in the Archives of Internal Medicine, researchers at Albert Einstein College of Medicine in New York City examined the records of more than 93,000 women - all over the age of 50 - enrolled in the Women's Health Initiative Observational Study. At the beginning of the study, questionnaires revealed that about 16 percent of the women qualified as depressed. Approximately half the women in this group were taking antidepressant drugs. After following the medical records of the subjects for an average of about four years, the results showed that postmenopausal women who were depressed but otherwise healthy were about 50 percent more likely to die of complications related to heart disease than those who were not depressed. And this risk level was the same among women taking antidepressant drugs. Researchers concluded that among women with no history of heart disease, depression was a reliable predictor of death due to a cardiac event. While this study reinforces the link between depression and heart disease, it doesn't shed any light on why the link exists. Does depression cause heart problems, or do heart problems cause depression? Some researchers speculate that the inactivity that often accompanies depression may promote an increase of inflammatory proteins (one of the risk factors of heart disease). Other studies have shown that depression may activate hormones associated with stress that are capable of constricting blood vessels. In both of these scenarios, an increase of omega-3 fatty acids might ease depression as well as heart disease risk. As we've seen in previous e-Alerts, omega-3 intake has been shown to alleviate symptoms of depression. For instance, researchers in the Netherlands conducted a study of more than 260 elderly and depressed subjects to examine how the ratio of omega-6 and omega-3 fatty acids might be associated with depression. Blood samples revealing omega-6 and omega-3 levels from all of these subjects were measured against a control group of 461 randomly selected subjects. Researchers found what they called a "direct effect of fatty acid composition on mood." Subjects with depressive disorders had a significantly higher ratio of omega-6 to omega-3 fatty acids. This is not a surprise, of course, but rather a confirmation that a low intake of omega-3 fatty acids may be at the root of depression, especially among older people. And in an e-Alert I sent you just last week ("Take it to Heart" 2/24/04), I told you about a study that examined 16 years of data, collected from more than 120,000 women. Researchers found that subjects in the group with the highest omega-3 intake had about half the risk of developing coronary heart disease compared to subjects in the group with the lowest intake. Overall, the relative risks of developing heart disease, dying from a cardiac event, or suffering a non-fatal heart attack all decreased steadily as fish consumption and omega-3 fatty acid intake increased. In spite of the fact that the Einstein College study concluded that antidepressant drugs didn't diminish the risk of heart disease in depressed patients, there's no doubt that most mainstream doctors would still automatically reach for the prescription pad to treat depression. But if the patient is elderly, this could be a dangerous choice. A 2003 study in the Archives of Internal Medicine examined the risk of bone fractures in more than 8,000 women over the age of 65. All of the women were taking some type of medication that affected the nervous system, such as the most commonly prescribed antidepressants. Over a period of five years, researchers found that the women had a significantly greater chance of sustaining fractures, compared to women who didn't take these types of drugs. When the data was broken down more specifically, women who took antidepressants were found to be 70 percent more likely to suffer disabling hip fractures. Researchers suspect that reduced alertness, prompted by the drug use, was to blame for the higher incidence of fractures. The results of the Einstein College study reinforce the growing awareness that there's much more to depression than feelings of anxiety and negativity. If you suffer from depression - even if your symptoms are moderate - tell your doctor or a healthcare professional, and ask them to closely monitor your heart health. To Your Good Health, Jenny Thompson
Health Sciences Institute Sources:
"Depression and Cardiovascular Sequelae in Postmenopausal Women: The Women's Health Institute (WHI)" Archives of Internal Medicine, Vol. 164, No. 3, 2/9/04, ncbi.nlm.nih.gov
"Depression, Heart Death Linked in Women" The Associated Press, 2/9/04, msnbc.com
"Plasma Fatty Acid Composition and Depression are Associated in the Elderly: The Rotterdam Study" American Journal of Clinical Nutrition, Vol. 78, No. 1, 40-46, July 2003, ajcn.org
"Low Omega-3 Levels Linked to 'Lows' in Elderly" NutraIngredients.com, 6/30/03, nutraingredients.com
"Depression may Boost Heart Risk" BBC News, 10/10/00, news.bbc.co.uk
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