Depression incites a host of deleterious psychological and physiological changes in our bodies, that eventually precipitate pathological changes in the cardiovascular system. A number of studies have demonstrated a close relationship between depression and increased incidence of and complications, including death, in patients with coronary heart disease. Cardiac patients with depression have higher readmission rates, longer hospital stays, undergo more procedures, and incur more medical expenses.

"Depression is a prison where you are both the suffering prisoner and the cruel jailer." - Dorothy Rowe, in Depression: The Way Out of Your Prison. Are you depressed? You may be suffering from 'major' depression if five or more of the following symptoms, including depressed mood or loss of interest, occur every day for at least two weeks: decreased interest or pleasure in activities once enjoyable, appetite change with weight loss or weight gain, persistent fatigue, tiredness or listlessness, feelings of being worthless or guilty, difficulty thinking, concentrating, remembering or making decisions, recurrent thoughts of death or suicide, being either agitated or slowed down, difficulty thinking, concentrating, remembering or making decisions, or having trouble with sleep - sleeping too much or too little, insomnia, waking too early, or oversleeping. Unfortunately, depression, like heart disease, is on the increase. According to The World Health Organization Global Burden of Disease Survey, major depression will become the second common cause of disability by the year 2020, after coronary heart disease.

Depression may be related to some unfortunate event or news. It is logical that mental anguish precipitated by the news of a potentially fatal heart disease, will lead to most people developing some degree of depression. "The damage to the heart, with its symbolic meaning as the essence of the human being, may shatter the patient's sense of wholeness and safety." Karni Ginzburg,Bob, Tel Aviv University, Israel. Depression in the general population affects about 1 in 20 people. A study published in the Journal of the American Medical Association reported that depression is more common among patients with heart disease. The results showed that 1 in 5 patients with coronary heart disease has depression, 1 in 3 patients with congestive heart failure has depression, and 1 in 2 patients hospitalized for surgery or other procedures to treat blocked heart arteries develop depression.

Does depression increase your risk of getting heart disease? In 1997, Lonas reported in the Archives of Family Medicine, results from the biggest population study in the United States - the NHANES study. This clinical trial began in 1960 with a survey of 6672 U.S. adults. After being followed for many years, researchers found that the risk of being hypertensive nearly doubled in whites and nearly tripled in blacks, if they scored high on anxiety and depression. A significant link has also been noted between depression and the development of coronary heart disease. This was noted in a study of 660 French power company employees,and reported in the International Journal of Epidemiology in 2004. Van Melle and colleagues, from the University Hospital, Groningen, Netherlands, reviewed 22 studies on depression after heart attack. The study, reported in the November/December, 2004 issue of the Journal of Psychosomatic Medicine, found that depressed heart attack patients were more than twice as likely to die of any cause and 2.5 times as likely to die of heart disease compared with those without depression

It is clear that depression is a bona fide risk factor for heart disease. "Life is ten percent what happens to you and ninety percent how you respond to it." - Lou Holtz. Depression can initiate damaging changes in your body, which include: endothelial dysfunction, increased platelet activity, increased inflammation, alteration in heart rate and decrease in heart rate variability, increased sympathetic activity, abnormal regulation of serotonin transporter, immune disturbances and decreased membrane levels of o-3 polyunsaturated fatty acids. . Heart surgery may also result in brain damage which in return may cause depression. And finally, depressed patients are less likely to take their heart medications. Many other mechanisms may also play a role.

Physicians are now targeting depression as one of the many potential therapeutic goals in patients with heart disease. Glassman and colleagues confirmed the improvement in heart health in depressed patients (SADHEART study) in the Journal of the American Medical Association in 2002. This and several other studies have firmly established the efficacy and safety of one group of antidepressants, the selective serotonin reuptake inhibitors (SSRIs), in this population. Unfortunately, depression, especially in the setting of heart disease, continues to be widely unrecognized and untreated. In the Archives of Internal Medicine in 2000, Canadian researchers reported that in patients with angina, only 8% of the depressed patients were prescribed an antidepressant drug at the time of discharge, as compared to 96% put on aspirin or an anticoagulant and 80% put on a beta blocker.

"Don't take life too seriously. You'll never get out alive." Bugs Bunny. If you have depression, especially with known heart disease, seek medical treatment. You will not only feel better, but you will improve your cardiac prognosis. Remember "Hope is like a bird that senses the dawn and carefully starts to sing while it is still dark." Treatment restores hope and will help you enjoy your life, everyday, including today. As Ken Lyons pointed out, "Yesterday is your cancelled check, tomorrow is a promissory note, today is the only cash you have, so spend it wisely."