Doctors have long been aware of the link between your mental and physical health, especially when it comes to your heart. Depression, anxiety, hostility, and stress can all increase a woman's heart disease risk and slow recovery. A study published March 17 in the Journal of the American College of Cardiology found that depression increases heart risk even in healthy women. The alarming new twist in this study was the discovery that women who take antidepressant medications are at increased risk for sudden cardiac death, although it is not known if the medications themselves cause the risk increase.
The study examined nearly 64,000 women without a history of heart disease or stroke who were enrolled in the Nurse's Health Study and followed them for about 12 years. The women answered questionnaires that assessed their mental health and use of antidepressant medications. Women who had symptoms of depression were about 50% more likely to die from heart disease than women without symptoms of depression, even when other risk factors for heart disease were taken into account. Women with depressive symptoms were also more likely to have characteristics that put them at risk for developing heart disease, including:
Surprisingly, when the results were broken down by medication use, researchers found that women who took antidepressant medications were more than three times as likely to suffer a sudden cardiac death (SCD)—when the heart stops and causes death within an hour of the first symptoms. SCD can be caused by a heart attack, a sudden heart rhythm problem, or other causes. Most SCDs (about 90%) happen in people who already have serious coronary artery disease, and two thirds of people who suffer a sudden cardiac death have already had a heart attack.
It is not clear how taking antidepressant medications is related to SCD. One possibility is that the drugs may make a woman more likely to develop a heart rhythm problem that, combined with existing coronary artery disease, could cause SCD. However, the finding does not necessarily mean that the antidepressant drugs themselves are dangerous: another explanation is that the women women with the most severe depression symptoms (who were already at the highest risk) were the most likely to require medication. The increased heart risk was limited to SCD: women taking antidepressants did not have a higher overall risk of dying of heart disease or of having a heart attack.
Women taking antidepressants should not stop taking them on the basis of this study: since the study was observational and not randomized, it is not possible to tell if the drugs caused the increased risk. Instead, some unknown factor could predispose women to both antidepressant medication use and heart problems. For doctors and scientists, this study highlights the need to look carefully at the heart benefits and risks of depression treatments.
The most important thing to remember from this study is that if you suffer from symptoms of depression or have been diagnosed as clinically depressed, getting your heart disease risk factors under control is especially important.
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Source: Whang W, Kubzansky LD, et al. Depression and Risk of Sudden Cardiac Death and Coronary Heart Disease in Women. Results From the Nurse's Health Study. J Am Coll Cardiol. 2009;53:950-8