Depression, Inflammation, Sleep, and Heart Disease

Overweight man having his blood pressure taken by a nurseApproximately 15% of people with cardiovascular disease and up to 20% of people who have undergone coronary artery bypass graft surgery experience major depression. Major depression is diagnosed when someone has experienced a number of depressive symptoms, such as sad mood, inability to enjoy things one used to enjoy (anhedonia), feelings of guilt, and changes in eating or sleep, daily for at least two weeks.

A link between depression and heart disease was first described in the 1980s. Research has shown that depression is a more significant risk factor for having additional cardiovascular events, such as another heart attack, than even heredity, smoking, and other lifestyle factors. In addition, depression following a heart attack has been associated with an increased risk of death.

Depression and Inflammation
Both depression and cardiovascular disease (CVD) are associated with increased inflammation. Until recently, however, it was unclear whether inflammation led to depression in those with CVD or whether depression led to increased inflammation in this population. A new study by Dr. Mary Whooley and colleagues at the University of California San Francisco has shed light on this relationship.

Earlier research had shown that higher white blood cell (WBC) count, a measure of inflammation, is associated with increased risk of atherosclerosis or hardening and narrowing of the arteries. Higher WBC counts also are linked to increased risk of cardiac mortality. The investigators sought to better understand the relationship between depressive symptoms and WBCs.

The team followed 667 participants who were enrolled as part of a larger, ongoing study, and assessed their levels of depressive symptoms and WBC counts over the course of a five-year period. What they found was that 21% of participants had significant symptoms of depression at two or more of the five annual evaluations. Recurrent depressive symptoms were associated with significantly greater inflammation as measured by WBC. This effect was independent of factors normally associated with higher risk of cardiac events, including age, gender, education, race, history of diabetes, heart attack, congestive heart failure, cardiac disease severity, aspirin use, physical activity, smoking, and baseline WBC count.

Poor Sleep Quality and Inflammation
Interestingly, participants’ sleep quality seemed to explain the relationship between depression and inflammation. The team concluded that depression may lead to sleep disturbance, and this in turn may increase both inflammation and the likelihood of worse heart health.

Why Is This Important?
The reason for the association between sleep and inflammation in depressed participants with CVD is unclear; however, one possibility is that chronic stress causes the bone marrow to overproduce white blood cells, and this effect may be more pronounced in those with sleep disturbances. These findings are important because previous studies have shown that elevated WBC count is a predictor of new cardiac events and cardiac death. If depression and poor sleep predict inflammation, these findings highlight the need to routinely assess mood and sleep in people with CVD and to treat these issues promptly.

What Can You Do?

  • Work with your medical team to create a healthy lifestyle plan that includes exercise and good nutrition. Both of these can help with mood, overall and cardiac health, and sleep quality.
  • Practice good stress management, including meditation. Meditation has been shown to help normalize blood pressure in people with hypertension, and it can also help one to notice distressing thoughts and feelings without getting carried away with or overwhelmed by them. A recent study also has found mindfulness meditation to help with insomnia.
  • Develop a good social support network. Reconnect with friends, family, or members of your religious community. If your network is limited, identify activities you have always wanted to engage in, such as joining a book club or taking a class. Use these as opportunities to begin meeting people who share similar interests. Social support is vital during recovery from serious illness.
  • See a professional. Psychotherapy, especially approaches that are interpersonally oriented, has been shown to be beneficial for those who have had a cardiac event.
  • Consider an antidepressant medication. Selective serotonin reuptake inhibitors (SSRIs) can be effective and are generally considered safe for people with CVD. A consultation with a psychiatrist who has worked with people with CVD can help you determine whether an antidepressant medication is appropriate.

References:

  1. Duivis, H. E., et al. (2013). Depressive symptoms and white blood cell count in coronary heart disease patients: Prospective findings from the Heart and Soul Study. Psychoneuroendocrinology, 38(4), 479-487.
  2. Cleveland Clinic: “Depression and Heart Disease” http://my.clevelandclinic.org/heart/prevention/stress/depressionandheart.aspx
  3. DiscoveryHealth.com: “Can Depression Cause Heart Attacks?” http://health.howstuffworks.com/mental-health/depression/questions/depression-cause-heart-attack.htm
  4. National Institute of Mental Health: “Depression and Heart Disease” http://www.nimh.nih.gov/health/publications/depression-and-heart-disease/depression-and-heart-disease.shtml

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  • Brigid

    Brigid

    April 10th, 2013 at 10:39 PM

    “Approximately 15% of people with cardiovascular disease and up to 20% of people who have undergone coronary artery bypass graft surgery experience major depression. ”

    Sobering fact! As a nurse, this is something we are trained to look for, but I didn’t know how wide spread the problem was. Thanks for bringing this to my attention!

  • Deidra

    Deidra

    April 10th, 2013 at 10:42 PM

    So, if you are depressed you are more likely to have another heart attack I guess I need to tell my grandma? my grandpa just had a heart attack so i’ll have to tell her to be on the look out for symptoms. I sure don’t want him to have another one scariest day ever!!!

  • Miriam

    Miriam

    April 10th, 2013 at 10:45 PM

    Depression definitely leads to sleep disruption. I always know I am cycling through a depression when I have no trouble falling asleep but then wake up in the middle of the night and can’t get back to sleep. I’ve always wondered if the irritability that comes with depression is from the depression itself of the presence of interrupted sleep.

  • Nathan

    Nathan

    April 10th, 2013 at 10:54 PM

    Therapy is a must. for people who just had a heart attack.
    I had one just a few years ago. If I didn’t have my therapist who knows what would have happened?
    I was always upset with everybody adn couldn’t get sleep at all.
    My therapist really helped me understand what was going one and helped me. To get better.

  • S Jacobson

    S Jacobson

    April 10th, 2013 at 10:56 PM

    Seems like a heart attack is a sign that significant changes need to be made. Having to start a brand new program of healthy diet and exercise after the stress of a major illness cannot be easy. It seems to me like it’d be a whole lot easier to eat healthier and exercise most days before an event so it’s one less thing to get used to. Of course, if you do those things, you may not even have to deal with the event in the first place. Isn’t that motivation enough for change?

  • Bess

    Bess

    April 11th, 2013 at 3:50 AM

    What I have noticed in a ot of heart patients is that they have their surgeries thinking that this is the answer, and that they don’t ever have to do anything else to change their lifestyles, that the surgery will take care of all of it. So they never start exercising, go back to eating the same things that they did before, take care or not care of themselves in the very same way, and then in a few months they are right back in the same position as before, These are the people that you want to look at and tell them to stop wasting your time, that they are not willing to change the bad habits that are leading them to this point, and that to me is very frustrating. To go through all of that and still be unwilling to change your lifesttle.

  • Glory B

    Glory B

    April 11th, 2013 at 11:41 AM

    The more I read about what an impact that sleep and the lack of it can play on your body, the more I realize that I need to be paying more attention to this!
    I always thought that if I could get about five hours of rest a night then I was doing good, but reading about how not getting enough can cause all sorts of things like depression and even heart disease?! I know now that I need to make good sleep patterns a priority in life.

  • Traci Stein

    Traci Stein

    April 11th, 2013 at 11:57 AM

    Thank you for reading and for your comments above. I couldn’t agree more that behavior change is essential, and also that it can be very difficult – in general and after a heart attack. Irritability, sleep disruptions, and difficulty adjusting to life post MI can be very challenging. Therapy and the above recommendations can make a meaningful – and possibly life changing difference.

    Be well!

  • Traci Stein

    Traci Stein

    April 11th, 2013 at 1:28 PM

    Hi Glory, I think the gist of this study is that if you have heart disease already, depression and sleep disturbance may lead to increased inflammation and worse outcomes. In terms of sleep, most people do best with 7-9 hours of good sleep, but too few people actually get this for a variety of reasons. Some people report not needing as much sleep, however. For these people, it may make less of a difference. Notice how alert and rested you feel after your normal amount and when you get more. That may be a good clue as to whether you are sleeping too little and/or not well enough.

    In general, I recommend striving to do your best regarding eating, exercise, sleep, and stress management while still allowing for normal variations (in other works, it’s okay if you are not always “perfect” with regard to the above, but strive to do what you can).

  • Glory B

    Glory B

    April 12th, 2013 at 3:59 AM

    Thanks, Traci!

    I am always trying to lead a healthier life, but well, you know, sometimes life gets in the way ;)

    This was kind of like my own little wake up call that I need to do something different, something better, to make the kind of changes that are going to be the most positive for me and provide the most lasting difference.

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