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Healthy Heart Reports

Depression Does Not Cause Heart Attacks

Articles have already appeared in medical journals recommending that doctors prescribe antidepressants for people who have heart attacks and are also depressed (10). This may be bad advice because there is no evidence that depression CAUSES heart attacks. Today's New England Journal of Medicine has a lead article showing that depression is not associated with heart attacks (11). 630 Army recruits were tested for hostility, depression, and stress. Then these men had a special test that measures the calcification in their arteries. There was no relationship between depression, stress or hostility with the amount of plaques in their arteries.

Plaques were associated with high cholesterol, high LDL cholesterol , triglycerides, and high blood pressure. How do you interpret this excellent peer reviewed study with three previous studies showing that depression is associated with heart attacks? First, there are no studies showing that stress causes heart attacks. Ther are three studies showing that people who are under stress are more likely to suffer heart attacks (7,8), but none of these studies show that stress causes heart attacks.

It is more likely that the same factors that cause heart attacks may also cause depression. In that case, the treatment is to correct the cause, not to prescribe antidepressants, and the cause of both depression and heart attacks may be lack of omega-3 fatty acids. Lack of omega-3 fatty acids in deep-water fish, whole grains, beans and seeds causes depression (1,2,3,4) and lack of omega-3 fatty acids also causes heart attacks (5). Lack of omega-3 fatty acids causes sticky platelets that causes clots to block arteries and cause heart attacks and people who are depressed have sticky platelets (6). So I recommend that depressed people take omega-3 fatty acids in nuts, seeds, beans, whole grains, and deep-water fish, and I recommend that people at increased risk for heart attacks also take in extra omega-3 fatty acids.

1) C B. Nemeroff, D Musselman, MD. Emory. Archives of General Psychiatry April, 1999.;56:381.

2) Edwards R, Peet M, Shay J, Horrobin D. Omega-3 polyunsaturated fatty acid levels in the diet and in red blood cell membranes of depressed patients. J Affect Disord. 1998;48:149-155.

3) Adams PB, Lawson S, Sanigorski A, Sinclair AJ. Arachidonic acid to eicosapentaenoic acid ratio in blood correlates positively with clinical symptoms of depression. Lipids. 1996;31:S-157-161.

4) Maes M, Smith R, Christophe A, Cosyns P, Desnyder R, Meltzer H. Fatty acid composition in major depression: decreased omega 3 fractions in cholesteryl esters and increased C20:4 omega-6/C20:5 omega-3 ratio in cholesteryl esters and phospholipids. J Affect Disord. 1996;38:35-46.

5) Musselman DL, Evans DL, Nemeroff CB. The relationship of depression to cardiovascular disease: epidemiology, biology, and treatment. Arch Gen Psychiatry. 1998;55:580-592.

6) CB Nemeroff, DL Musselman. Are platelets the link between depression and ischemic heart disease? American Heart Journal, 2000, Vol 140, Iss 4, Suppl. S, pp 557-562.

7) CM OConnor, PA Gurbel, VI Serebruany. Depression and ischemic heart disease. American Heart Journal, 2000, Vol 140, Iss 4, Suppl. S, pp 563-569.

8) KRR Krishnan. Depression as a contributing factor in cerebrovascular disease. American Heart Journal, 2000, Vol 140, Iss 4, Suppl. S, pp 570-576.

9) JM Gorman, RP Sloan. Heart rate variability in depressive and anxiety disorders. American Heart Journal, 2000, Vol 140, Iss 4, Suppl. S, pp 577-583.

10) SP Roose. Considerations for the use of antidepressants in patients with cardiovascular disease. American Heart Journal, 2000, Vol 140, Iss 4, Suppl. S, pp 584-588.

11) NEJM November 2, 2000


Copyright 2000
Dr. Mirkin's opinions and the references cited are for information only, and are not intended to diagnose or prescribe. For your specific diagnosis and treatment, consult your doctor or health care provider.

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