For some time now scientists have believed there is a strong link between depression and heart disease. Standard treatment for depression has often included an antidepressant as well as psychotherapy. But now a recent study in Canada, published in the Journal of the American Medical Association, indicates that for some heart patients, medicine may be more effective than talking out their problems to a clinical psychologist or psychiatrist.
What goes on in the brain, they say, often influences what goes on in the heart. A finding of the World Health Organization from a decade ago still holds true today: that depressed people tend to get sick more often.
In fact, the W.H.O. reports the death rate of older patients suffering from depression is four times higher than those who are not depressed, and most die from heart disease or stroke.
Sixty-five year old Edward Pietrantonio was experiencing a bout of depression when he had a heart attack 15 years ago.
"I went through the death of someone that was very close to me and we had problems in the family and everything came at once and then the heart gave out."
His physical and mental illnesses were typical of almost 300 patients who participated in the Canadian study. One group took antidepressants and the other participated each week in sessions with a therapist.
"It has been known for many years that depression is highly prevalent in patients with heart disease, so we wanted to evaluate two treatments of depression."
Dr. Francois Lesperance of the University of Montreal says the results were surprising:
"...it's like trying to deal with two issues at the same time. The difficulty to deal with the social issues and the stresses and talking about them at the same time having [a] physical disease was a big challenge and patients with heart disease seem to have difficulty to do that."
One group of patients took citalopram. It is an antidepressant that comes from a class of drugs known as Selective Serotonin Reuptake Inhibitors, or SSRI's for short. Citalopram is also known under the brand names of Celexa and Lexapro.
Dr. Lesperance says this drug was chosen because it has a low risk of a dangerous interaction with another drug. That is an important factor for many heart patients already taking multiple medications. The antidepressant helps relieve the depression by raising the level of serotonin in the brain. Again, Dr. Lesperance:
"An antidepressant working on the serotonin system in the brain was helping the patient with depression, improving their depressive symptoms."
When the level of serotonin was increased in the brain, mood improved. The Canadian study also concluded that patients who depended on weekly sessions with a psychotherapist showed no more improvement than a short visit to the doctor for a minimal checkup.
Dr. Lesperance says the researchers were not sure why there was no significant improvement:
"Talking about these issues, trying to make changes, seems to have been difficult for patients with heart disease."
Dr. Lesperance still believes talk therapy is beneficial to many people and that further comparison of antidepressants and other forms of mental therapy are needed.
As a psychiatrist, he urges people to take their emotional feelings seriously. Patient Edward Pietrantonio agrees the first step toward treatment is asking for help:
"They should go see a doctor. That's all I have to say. See a doctor. Don't wait. That's it.!!"