Depression

Photo Credit: Ashley Laderer

Photo Credit: Ashley Laderer

Abstract

Depression is one of the most common mental illnesses within the United States and it is continuing to affect millions within the twenty-first century. Nearly 20 million people suffer from depression and/or anxiety (depressive symptoms) and have experienced at least one major episode, which required psychotherapy and/or medicinal management. From a global perspective, 350 million people suffer depression throughout the world (World Health Organization, 2015). This disease is common among children, women, and men of all ages, and if not detected, can provoke negative, long-term effects. Depression has been linked to coronary disease and literary discoveries have supported this inclination due to how biological ailments have directly influenced psychological issues. This paper will examine how depression impacts cardiovascular diseases and how proper treatment (screenings) should be implemented to handle both serious illnesses. Additionally, this assignment will discuss how scholarly studies have conducted experiments to determine the severity of how depressive symptoms can exacerbate heart disease.

          Keywords:  Anxiety, cardiovascular disease, depression, depressive symptoms, heart disease, mental illness, mood disorder, symptoms

Introduction

          Depression is a major mood disorder, which is considered one of the most common depressive illnesses within the United States. The clinical depressive disorder significantly affects an individual’s cognitive, emotional, and functional activities, impacting one’s ability to complete normal routines. To be diagnosed with depression, an individual must experience symptoms for at least two weeks or longer (National Institute of Mental Health [NIH], n.d.). Approximately 19 million adolescents and adults suffer from depression within the United States and it considered the most dangerous form of mental illness because it does not necessarily dissipate (U.S. National Library of Medicine, 2018). Indications of depression can be sporadic or appear to go into remission and that is why it is dependent upon those who are diagnosed to receive the proper treatment. 

          According to the U.S. National Library of Medicine, depression consists of the following symptoms: feeling sad or empty, loss of interest in activities, overeating, starving, insomnia or problems sleeping, tiredness, anxiousness or feeling hopeless, and aches and pains (2018, para. 1). The most alarming and life-threatening symptom of depression is suicidal attempts and/or thoughts or death. Data from the National Vital Statistics Reports stated that approximately 50 percent of 19 million citizens diagnosed with major depressive die via suicide (Murphy et al., 2017). There are six common forms of depression: major depression, persistent depressive disorder, bipolar disorder, seasonal affective disorder (SAD), perinatal depression, and PMDD (premenstrual syndrome (Harvard Medical School, 2018). Each form has its own symptoms and treatments to ensure diagnosed individuals receive the proper care and therapy.

          Major depression is one of the most common forms of the mental illness and is predicated on the previously discussed symptoms. The disorder can be treated with psychotherapy and antidepressant prescriptions. However, those who have a severe form of major depression may need electroconvulsive therapy, which is a type of intensive therapy that sends electric currents through an individual’s brain to provoke seizures and mitigate severe mental issues (Lilienfeld & Arkowitz, 2014). Persistent depressive disorder is a mental illness that lasts for at least two years, but not significant enough to be considered a major depressive disorder. Some of the symptoms are like the major depression type, but individuals can function, as it is not all-encompassing or severe. Bipolar disorder is a mood and behavioral disorder that provokes elements of manic and depressive conduct that is prolonged for a specific period. Most individuals who are diagnosed with bipolar disorder have expressed manic-depressive symptoms for months. The manic state is usually a shorter period than the depressive state, in which specific medication is needed to alleviate a diagnosed individual’s moods and behaviors. 

          Seasonal affective disorder (SAD) is a mental disorder that is dependent upon the seasonal changes and environment. Experts states SAD transpires in the fall and winter due to how moods and behaviors are affected by the weather (Harvard Medical School, 2018). Treatment for SAD is a little unorthodox from other types of depressive orders, as individuals need direct lighting sources (light therapy. However, medicine and psychotherapy are promising treatment solutions in addition to light therapy. Perinatal depression(or maternal depression) is a form of mental depression that resonates within women during pregnancy and/or the first year after birth (New York Department of Health, n.d.). Symptoms are like major and persistent depression and women can find treatment through psychotherapy and support groups. Finally, premenstrual syndrome (PMDD) is the concept of depression through severe forms of a woman’s cycle, which affects the ovulation and menstruation processes. Women can be treated through hormone medication, antidepressants, and pain management for PMDD (National Institutes of Health, 2017). PMDD is considered a severe, hormonal issue that is predicated on psychological problems due to the inconceivable pain a woman experiences during her cycle, which can lead to depression. 

          Apart from perinatal and PMDD depressive orders, which affect women, the other four types of depression affect children, women, and men of all ages. Because the symptoms do not necessarily dissipate and treatment is needed to mitigate mood and altered behaviors, it is imperative that those who are diagnosed follow their trained professional’s orders to maintain a decent and healthy life. Research has found that prolonged, untreated symptoms have led to long-term illness of depression and other biological sicknesses. That is why it is important for those to be thoroughly screened by trained clinicians and other professionals when symptoms persist. This paper will discuss how biological illness, such as heart disease, can materialize through depression. This research assignment will also examine how the lack of proper screenings can impact heart disease. 

Literature Review             

          It is not uncommon for depression to correlate with heart disease due to long-term effects and/or untreated prognosis. Individuals who are diagnosed with depression have double the chances of having heart disease (Harvard Medical School, 2018). Research has shown that in addition to depression as a psychological illness, it can cause inflammation and negatively impact the arterial wall (from a biological perspective). Inflammation can cause artery blockage, producing a rupture effect inside those walls. Furthermore, severe depression produces excess stress hormones that requires increased blood flow, which leads to clots within the arterial wall. 

          Palacios, Khondoker, Mann, Tylee, and Hotopf (2018) expressed depressive symptoms are primary signs of coronary heart disease based on prolonged symptoms of the mental illness. The authors suggested there is a correlation between the two, even though a significant amount of research is believed that the symptoms are only responsible for medical episodes that are minute. To determine the prognosis, 803 individuals diagnosed with coronary heart disease participated in an experiment; data was collected, along with observation and analysis over six month periods for three years (Palacios et al., 2018, para. 3). The latent growth analysis was the data collection tool used to formulate five categorical routes, which were based on the Hospital Anxiety and Depression Questionnaire: stable low, chronic high, improving, worsening, and fluctuating (Palacios et al., 2018, para. 3). Participants also used the Social Problem Questionnaire and the Client Survey Receipt Inventory to determine social and financial issues (constant health care costs), which may be factors for depression. Finally, researchers conducted an in-person interview and telephonic with participants after the primary questionnaires were completed.

          Results showed approximately 19 percent of the participants (803) showed signs of depression and/or anxiety disorders. Within the 19 percent, the statistical data that 54 participants suffered minor, reasonable, and austere depressing behaviors and 29 had symptoms of panic attack disorder (Palacios, 2018). Nearly 70 participants had a mixture of depression and anxiety disorder. Retention rates were significantly high and much of the participants returned to researchers for follow-up assessments. Unfortunately, 18 percent of the participants’ data was lost, affecting credibility and validity standards and solid results for the study. Additional limiting factors were those who did not follow-up for continuing assessments due to unforeseen circumstances. Sadly, 44 participants died from coronary heart disease complications and 28 from other medical matters. The demographical information consisted of primary white males at nearly 70 percent (sex) and almost 90 percent (ethnic and racial background). 

          Related research conducted by Moise et al. (2018) revealed that psychological issues, such as depression, is associated with medical illness, which results in death. Four hundred and ninety-one participants, within in American households, participated in the study to determine if there was an association between depressive symptoms and cardiovascular illnesses that cause death. Researchers used the Reasons for Geographic and Racial Differences in Stroke (REGARDS) and the proportional hazard regression models research designs to collect data.

           The results showed that based on the data collected from both assessments that cancer and cardiovascular diseases caused death (Moise et al., 2018). Fifty-five percent of the participant population were women whose who average age was approximately 65 years. Of the women population, 41 percent were African American, and 11 percent had increased depressive symptoms. Finally, 54 percent of the women were known to have fair or good health based on their medical information collected from participants. Depression was closely correlated with cardiovascular disease and based on the demographical information, chronic clinical diseases, and psychological factors heightened the results (Moise et al., 2018). The study showed that “time-varying” depressive behaviors caused a boosted risk for death and diseases such as cancer and cardiovascular disease were found in those good and/or excellent health. 

          Linked research by Simning, Seplaki, and Conwell (2017) determined if severe depression resulted in heart attacks and/or strokes. The experts used the National Health and Aging Trends Study (NHATS) and 5,643 individuals participated based on social contacts as the primary tool for collecting data. The survey is highly used among senior citizens who Medicare beneficiaries that determine health issues among forms of depression. In addition to NHATS, researchers used the Patient Health Questionnaire to focus on symptoms of depression, social interactions, and follow-up assessments. 

          Results found that 297 of the 5,643 participants reported having a heart attack and/or stroke between the initial and follow-up appointments. Older adults with no social contacts had significantly higher chances of depression than those who had social interaction and supports groups. Those who had social contacts had increased levels of depressing symptoms at the follow-up assessment period, but did not have a heart attack; instead those at the follow-up tended to have a stroke. 

          Pike et al. (2018) examined whether single ventricle heart disease is aligned with depression and anxiety disorders. Also, the researchers wanted to determine if cognitive, anxiety, and depression behaviors were impacted by studying brain tissues from brain injuries. By doing so, magnetic resonance imaging (MRIs) were conducted to observe organs and soft tissues through pictures. Like Simning, Seplaki, and Conwell’s study, the experts used the Patient Health Questionnaire, in addition to the Montreal Cognitive Assessment for 36 participants to participant in a control group. The population consisted of individuals who had a heart attack and/or stroke during the initial and follow-up assessments. 

          Results disclosed that several participants showed increased actions in their brain activity (those with injuries) and show signs of depressive symptoms. Additionally, single ventricle heart disease signs were higher in males than females. Another similar study was Dua et al.’s (2018) experiment on comparing anxiety and depression with chronic obstructive pulmonary disease (COPD). The researchers focused on COPD to investigate whether psychiatric comorbities are amalgamated with depression and anxiety, which can cause heart disease. This study is especially intriguing because Indian experts were working on the same psychological lineage to heart disease like American scholars within the United States. 

          Dua et al.’s (2018) research methodology and research design was predicated on the Hospital Anxiety and Depression Scale, the International Classification of Diseases, Tenth Edition Diagnostic Criteria for Research, the Clinical COPD Questionnaire, and the Modified Medical Research Council Scale. For this study, 128 participants, who were part of the Outpatient Department of AIIMS Riskikesh, volunteered for the experiment. Dependent upon the base line for the initial screening, participants were transferred to take additional psychiatric screenings. The experiment was conducted for a year, which was based on those who had previous hospitalizations. 

          Results found that participants with COPD and depression or anxiety exposed higher scores of those who did not. However, participants whose current smoking, body mass index, and hospitalization data was not significant factors within the overall results. Depression was an underlining factor of COPD, which mitigated an individual’s quality of life. Finally, another related study completed by Penninx (2017) centralized the focus on depression and cardiovascular disease. The reasoning of the research was to continue if specific lifestyles influenced depressive symptoms along with cardiovascular disease and discuss some of the limiting factors between treatment and heart ailments. 

          Penninx concluded that major depressive disorder increases the risk of cardiovascular disease by 80 percent (2018). The researcher suggested that such factors due to the disease are based on harmful lifestyles and adverse pathophysiological disorders. Much literary discoveries were based on the Netherlands Study of Depression and Anxiety. Those diagnosed with depression were known to have significantly unhealthy lifestyles and scores were significantly higher than those who were healthy. 

Conclusion

Depression is a serious mental illness, and with proper screenings and correct diagnosis, is instrumental in ensuring proper treatment. There are six types of depression that affect approximately 19 million people (and counting), and with suicide as the leading death with the disease, it is crucial they receive help. Major depressive disorder is the most severe and prevalent type of disorder that affects an individual’s overall way of life. All types should be taken seriously, as prolonged symptoms can lead to long-term illness and even other biological diseases. This paper determined those who were diagnosed with depression had prolonged symptoms and effects showed a definitive link to cardiovascular disease. 

          Research has shown that depression leads to heart disease through extended states of untreated symptoms and the biological aspect of how the mental illness directly affects the heart. Six similar studies were included in paper to show how depression impacts and/or exacerbates heart disease. Experts used similar and dissociative questionnaires and assessments to determine linkage. Most research was focused on an older age group-- those who had experienced heart ailments before and during the experiments. Also, the research studies included those who had long histories of unhealthy habits. Based on the similar studies and results, it would be intuitive to formulate innovative methods to determine this problem. 

           Palacios, Khondoker, Mann, Tylee, and Hotopf (2018) found that participants with coronary heart disease have a higher risk of depression, which provokes Medicare costs, exacerbating such symptoms. Researchers believe handling heart disease in a proper manner is the key to mitigating depression and anxiety. Additionally, it is imperative that policymakers make this a primary concern and establish future trials to determine if managing the disease in fact decreases depression and/or anxiety. 

            Moise et al. (2018) found that depressive symptoms lead to cancer and cardiovascular disease, even those in good health. Experts believe that is dependent upon patients to manage their illness with proper treatment and medicine to prevent depressive symptoms. Those in excellent health still need to be closely managed to prevent serious events such as heart attacks and/or strokes. Simning, Seplaki, and Conwell (2017) emphatically expressed that older age groups have increased levels of heart diseases and higher risk of depressive symptoms, especially those who have had strokes. Participants who had not social contact with others had a significant increase in having depression, especially following a heart attack. The researchers believe that social interaction may play an imperative role with older adults experiencing minor health problems that link to depressive symptoms. They suggest future experiments should be conducted to determine if causal relationships affect health issues; if it can be definitively established, then trained professionals should establish interventions to mitigate depressive symptoms among senior adults. 

           Pike et al.’s study (2018) focused on adolescents and how serious brain injuries formulated and/or heightened depression and anxiety. They suggested that it would be beneficial to conduct future studies and determine if functional deficits play a role or if the impact of damage, which pain management is needed for consideration of depressive symptoms. Dua et al. (2017) emphasized that depression is a common illness, which leads to increased symptoms of depressive behavior, decreasing the health of COPD patients. Recommendations are to conduct clinical trials to determine the severity of decreasing health of COPD patients and to manage treatment through educating healthy lifestyles, proper medical treatment, and psychotherapy. Finally, Penninx (2018) acknowledged the need to express alternative methods for treating patients with heart disease who suffer from depression. Both illnesses need to be addressed separately since there are different treatments based on the severity and/or miniscule perception of both. 

            Understanding the close relationship between depression and heart disease, it is essential that diagnosed individuals should work together with trained professionals. It is very important that there are clear lines of communication because two major illnesses are involved, which can lead to an untimely death if misdiagnosed or goes untreated. It would be beneficial that both patient and trained expert are aware of the entire medical history, therapy recommendations, medicine, and lifestyle to determine how an individual who deals with both can be managed and live a decent life. It is also intuitive if trained experts work closely with policymakers to find innovative strategies that can amalgamate therapy, medicinal management, social interaction, and healthy living programs to treat depression and cardiovascular disease. These are the recommended courses of actions from the six studies reviewed and if there was an all-inclusive program to address all issues, there could be increased chance of better lifestyle and longevity for those who have depression and heart disease. 

 

References

Dua, R., Das, A., Kumar, A., Kumar, S., Mishra, M., & Sharma, K. (2018). Association of comorbid anxiety and depression with chronic obstructive pulmonary disease. Lung India. Retrieved from http://www.lungindia.com/article.asp?issn=0970-2113;year=2018;volume=35;issue=1;spage=31;epage=36;aulast=Dua (accessed on 22 June 2018). 

Harvard Medical School. (2018). Depression and heart disease: A two-way street. Harvard Health Publishing. Retrieved from https://www.health.harvard.edu/heart-health/depression-and-heart-disease-a-two-way-street (accessed on 20 June 2018). 

Harvard Medical School. (2018). Six common depression types. Harvard Health Publishing. Retrieved from https://www.health.harvard.edu/mind-and-mood/six-common-depression-types (accessed on 15 June 2018). 

Lilenfeld, S. O. & Arkowitze, H. (2014). The truth about shock therapy: Electroconvulsive therapy is a reasonably safe solution for some severe mental illnesses. Scientific American. Retrieved from https://www.scientificamerican.com/article/the-truth-about-shock-therapy/ (accessed on 19 June 2018). 

Moise, N., Khodneva, Y., Jannat-Khan, D. P., Richman, J., Davidson, K. W., Kronish, I. M., Shaffer, J., & Safford, M. M. (2018). Observational study of the differential impact of time-varying depressive symptoms of all-cause and cause-specific mortality by health status in community-dwelling adults: The REGARDS study. BMJ Journals. Retrieved from http://bmjopen.bmj.com/content/8/1/e017385 (accessed on 21 June 2018). 

Murphy, S. L., Xu, J. (MD). Kochanek, K. D., Curtin, S. C., & Arias, E. (2017). Deaths: Final data for 2015. National Vital Statistics Reports, 66(6), pp. 1-73. 

National Institutes of Health. (2017). Premenstrual syndrome: Overview. Retrieved from https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0072449/ (accessed on 19 June 2018). 

National Institute of Mental Health. (n.d.). Depression. Retrieved from https://www.nimh.nih.gov/health/topics/depression/index.shtml (accessed on 17 June 2018). 

New York Department of Health. (n.d.). Maternal depression. Retrieved from https://www.health.ny.gov/community/pregnancy/health_care/perinatal/perinatal_depression.htm (19 June 2018). 

Palacios, J., Khondoker, M., Mann, A., Tylee, A., & Hotopf, M. (2018). Depression and anxiety symptom trajectories in coronary heart disease: Associations with measures of disability and impact on 3-year health care costs. Journal of Psychosomatic Research, 104, pp. 1-8.

Pike, PhD, N. A., Roy, PhD B., Gupta, R., Singh, PhD, S., Woo, PhD, M. A., Halnon, MD, N. J., Lewis, MD, A. B., & Kumar, PhD, R. (2018). Brain abnormalities in cognition, anxiety, and depression regulatory regions in adolescents with single ventricle heart disease. Journal of Neuroscience Research: Wiley Online Library. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1002/jnr.24215 (22 June 2018). 

Simning, A., Seplaki, C. L., & Conwell, Y. (2017). The association of a heart attack or stroke with depressive symptoms stratified by the presence of a close social contact: Findings from the National Health and Aging Trends Study Cohort. Wiley Online Library. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1002/gps.4684 (accessed on 21 June 2018). 

U.S. National Library of Medicine. (2018). Depression: Clinical depression, dysthymic disorder, major depressive disorder, unipolar depression. Medicine Plus. Retrieved from https://medlineplus.gov/depression.html (accessed on 17 June 2018).

 

 

 

Dr. Monique Chouraeshkenazi