Dr. Robert Carney
In folklore, it’s common sense: When you’re sad, your heart’s hurt.
But in medicine, the connection between depression and heart disease wasn’t made until the late 1980s. Dr. Robert Carney, professor of psychiatry and director of the Behavioral Medicine Center at Washington University School of Medicine, helped conduct one of the first published studies. “If people are depressed,” he says, “they are two to three times more likely to die from their heart disease or have another heart attack than someone who is not depressed.”
The depression doesn’t have to be severe, either. “Even two or three symptoms of depression will slightly increase your risk,” he says.
Carney was on the American Heart Association scientific committee that recently recommended listing depression as a risk factor for heart disease—right up there with smoking and high blood pressure.
Now he’s trying to understand why depression worsens heart disease.
First, there’s behavior: When you’re depressed, it’s harder to eat well and exercise, easier to smoke and drink and overeat and slump on the sofa.
Second, depression alters the autonomic nervous system, heightening the stress response and therefore speeding up heart rate and blood pressure.
Third, there’s inflammation, which plays a role in clinical depression and several other mental illnesses. Our bodies need the inflammatory process when they’re injured, in order to heal. But when inflammation becomes chronic, it does real damage, increasing both the amount and the instability of the plaque that can clog our arteries.
That’s a fertile area for the next phase of Carney’s research: a clinical trial that adds an Omega 3 supplement to an antidepressant, Zoloft. “Two traditional treatments for depression are safe for people with heart disease, this class of antidepressants and cognitive-behavioral therapy,” says Carney. “The problem with both is, they’re just not as effective as we’d like. They don’t improve depression in everyone, and you don’t get that many people who wind up without any depression. And we know that even a few symptoms of depression predict recurrent depression and heart disease.”
Everyone in the study will take Zoloft, and half of the participants will also take the supplement, while the other half take a placebo. “We think the Omega 3 can help augment the effects of the antidepressant.” He’s quick to add, though, that this is a highly refined, specific type of Omega 3, not the health store variety.
Carney’s not urging us to rush out and buy Omega 3 supplements, though. “What we know is that a certain form of Omega 3 competes with the development of pre-inflammatory molecules. But this is lab stuff under highly controlled conditions. In order to get the doses in these studies with over-the-counter supplements, you’d have to exceed recommended dosage.”
If you have heart disease and are depressed but otherwise relatively healthy and you’re interested in enrolling in the study, call 314-286-1360.
