A recent Harvard study indicates that some forty to sixty-five percent of heart attack survivors suffer depression. Cardiac mortality risk increases seven times for heart patients with depression. We now know that depression results in alterations in blood chemistry, remarkably increasing the chance for stroke or heart attack. A positive attitude is not only associated with better outcomes for heart attack patients, but may even help to stave off heart disease. Cardiac patients with more entrenched depression were less likely to take positive steps to address their health and had higher blood pressure. More of them were also diagnosed with diabetes. John Hopkins researchers followed nearly 500 older patients and found that those with personality assessments reflecting a sunny outlook were half as likely to experience heart problems as those who were depressed.
In a four year Finnish study of six hundred middle-aged men, it was found that depressed men were three times mores likely than average to develop high blood pressure even when factors such as weight, smoking, age, exercise habits, alcohol and education were parceled out. There is a twenty-five percent depression rate among cancer patients. Stroke survivors claim a depression rate of twenty percent. Low levels of serotonin, a neurotransmitter associated with well being, may also result in higher blood pressure. Low serotonin levels are often found in the blood serum of people who attempt suicide, the eighth leading cause of death among Americans and the second leading cause of death among American youth.
We have been aware for many years that depression affects our ability to ward off diseases. If depression continues long enough, even mild depression can cause changes in our immune system. Older people are particularly vulnerable to the immunosuppressant effects of depression. Scientists have learned that some side effects of an over active immune system can result in a chronic inflammation response, releasing pro-inflammatory blood proteins called cytokines. This can have disastrous physical effects including an increased blood-clotting factor that could result in stroke or heart attack.
There are many theories about the etiology of depression. Almost all of them point to changes our brain chemistry, which is exactly what is targeted by antidepressant medications. (Note: the newer serotonin antidepressants, i.e. Prozac, Zoloft etc., are far more helpful to cardiac patients than the older (triclyclic) antidepressants, as there is no arrhythmic side effect.) Optimism is a personality trait that we know to be genetically linked. Depression also seems to be related to a genetic predisposition in some people. If nature evolves to select the fittest, then why are so many people depressed? It could be that depression may be a useful response to difficult situations where paths to change cannot be found. It may actually help a person disengage from impossible positions and move on to something that works. However, depression is most often immobilizing. Sometimes cognitive therapy and antidepressant medication are needed to "kick start change into motion." In fact, brain scans of depressed people demonstrate an abnormally active emotional system but a remarkable deficit of activity in the frontal lobe thought centers. Once depression is lifted brain imaging depicts decreases in emotional activity, and thought centers begin to light up. Thoughtful proactivity is in fact a kind of antidepressant.
Even though one may have a genetic predisposition to depression, early life "imprint learning' experiences clearly play a seminal role. The brain and body are one and the same. All aspects of our internal and external daily experience affect our brain chemistry. Negative thoughts, ruminating on negativity, anger or worry can engender biochemical states of depression, anger and fear. If you grew up with family members who repetitively role modeled angry, negative or anxious thinking patterns, it is highly likely that you too may have these slanted cognitions that result in internal stress and unhappiness. It is important for your mental and physical health to learn to override these patterns and to establish new, more habitual positive ways of thinking.
Some twenty million Americans experience depression in any given year. Only thirty percent of these depressed people will seek treatment. Depression is when "I have me on my mind." Interestingly, after a certain subsistence level, money does not seem to be related to well being. Research indicates that our social context is a far more important factor. It appears that we would do well to set up our social environment so that we interact with a sense of meaning and validation. Our experience of a positive social context changes as we grow and age. For example, our teen focus of "fitting in" is likely to be of much less importance later. As we reach adulthood, work, goals and congenial family and colleagues become essential. (I urge people to think of toxic people and places like toxic food - something to avoid). As we retire, social context may dramatically change again. It is important to find a group where esteem and regard are plentiful and where goals and focus may be meaningfully channeled. For example some older adults may find enormous pleasure and purpose attending to the "genes going forward" - the grandchildren.
Psychotherapy, especially cognitive behavioral strategies, can help depressed people make a plan to set up a lifestyle that mitigates against depression. Sometimes, but not always, the strategy may include an antidepressant. Many psychologists use medication to get started only if necessary. Once therapy begins patient and therapist collaborate to individualize a life plan that incorporates daily routines of exercise, social support, careful thinking, sleep hygiene, nutrition, and spirituality.
It is crucial to our health and happiness to be aware of depression. Life is a moment. Intensified negative emotions can rob us our moment, leaving us physically sick or even worse sick at heart.
- Dr. Linda Klaitz, Medical Psychologist