Millions of Americans live with clinical depression, one of the most common mental disorders in the United States, according to the National Institute of Mental Health. This mental health disorder, characterized by persistently depressed mood or loss of interest in activities, can also impact a person's physical health, including heart health.
This May, Mental Health Month, Shammah Williams, MD, an interventional cardiology fellow at Loma Linda University School of Medicine, delineates how depression can impact heart health and offers concrete actions for safeguarding heart health throughout depression.
“Chemical imbalances inside the brain can cause the medical condition we call depression, but this description does not fully encompass the complexity of this illness,” Williams says. Genetics, abnormal mood regulation, perception, and stressful events all play a role in the development of depression. “Even if someone with depression wants to do things they once enjoyed or need to get done, they may be unable to do those things.”
Williams says lack of interest, motivation, energy, and concentration are just a few symptoms of depression that can indirectly affect heart health through alterations in eating habits, nonadherence to medications, or lack of physical activity.
Over time, Williams says a sedentary lifestyle can contribute to developing conditions like high blood pressure, diabetes mellitus, high cholesterol, and obesity. “As these conditions develop, the risk associated with almost all forms of cardiovascular disease increase[s], too,” Williams says.
Depression can also precipitate disruptions in appetite, causing people to eat too much or too little and usually gravitate towards less healthy food options, Williams says, adding that the body will attempt to utilize, store, or discard these food sources, but only to a certain point.
When the body receives too much sugar or fat and proper storage options have been exhausted, the body may store these products in abnormal places, like the lining of our arteries. High intake of fat (particularly saturated fat) and sugar contributes to the development of LDL (bad) cholesterol. This LDL cholesterol then deposits in the lining of the blood vessels, creating plaque. This plaque encroaches on the lumen of the blood vessel, which leads to decreased blood flow. If severe, it may cause a heart attack or stroke.
Moreover, past studies have demonstrated a direct link between depression and endothelial dysfunction, an abnormality of the lining of the arteries, called the endothelium, responsible for regulating blood flow to the heart.
“In the setting of depression, those regulatory mechanisms can become defective,” Williams says. Endothelial dysfunction heightens one’s risk of developing atherosclerosis, when arteries narrow from plaque buildup.
Sleep disruption is another common symptom of depression that affects the heart. Lack of sleep does not allow the heart, a muscle that needs rest, enough time to recover from the day’s activities, Williams says. “In general, everything inside of our body when we go to sleep ramps down, including the heart. While the heart is a muscle that never stops beating, it is a muscle that needs to go down to a lower gear. So if you're unable to do that, your heart remains under increased stress.”
On the other hand, Williams says too much sleep lessens the likelihood and chance of engaging in the amount of physical activity that’s helpful for heart health: three to four times a week for 20–30 minutes. Exercise possesses a stress-relieving function by releasing endorphins and providing the heart a “healthy stress test” without causing any significant harm, he says. Exercise causes the heart to become more efficient as a pump and ultimately reduces the work of the heart by lowering heart rates and blood pressure. It can also increase development of HDL (good) cholesterol.
Unfortunately, depression often leaves people feeling too fatigued or unmotivated to engage in activities they enjoy. Williams says it can also cause people to feel they are utterly alone or without care. The pandemic could have further exacerbated such sentiments of isolation, he says.
Thus, building support among members of family or social groups, whether in-person or online, is especially beneficial for the mental and physical health of those with depression. Williams says people with depression benefit from a network of people, even one person with whom they can connect in times of loneliness, or a gym partner with whom to exercise. Engaging in forms of talk therapy with a professional who is not integrated into the immediate social network can also be relieving for people, he says.
It’s also possible to address the anxiety or depression people may feel with medications prescribed by a physician, whether they be for a short or long term, Williams says. Medications can allow patients to rise above crippling mental struggles and enable a frame of mind for the patient to engage in meaningful life activities, self-care, self-love, and heart-healthy behavior, he says.
Whether or not you struggle with depression, Williams says one of the most helpful actions you can take is to help break the stigma associated with it. “We need to normalize depression as a medical condition in the same way we have normalized high blood pressure.”
Because of stigmas tied to depression, Williams says people may not want to admit to feeling depressed, avoid seeking help when it is present, or miss the warning signs altogether. Normalizing depression can help foster education about the condition and equip people to seek help. Accessing help for depression will bear repercussions in boosting both mental health and physical health, Williams says.
If you or a loved one struggle with depression, Williams advises talking to your cardiologist and doctors openly about how you feel, both physically and mentally. The International Heart Institute is here to help you or your loved ones navigate heart care through every step. For more information or to schedule an appointment, call 1-800-468-5432.