Chapter 5 Depression really does hurt your heart: stress, depression, and cardiovascular disease

Abstract

The interplay of stress, personality traits, and psychiatric symptoms syndromes with the cardiovascular system, has long intrigued investigators in their search for psychosocial and psychiatric contributions for the development and progression of atherosclerotic heart disease. Surveillance of the established risk factors for atherosclerotic heart disease (IHD), e.g. smoking, hypertension, hypercholesterolemia, and age, leave a substantial portion of the differences in rates of IHD unexplained. Indeed, the Type A personality pattern has been extensively studied as a risk factor for coronary artery disease, (CAD). However, increasing evidence is accumulating suggesting that an affective disorder, major depression, is a major contributing factor, not only to elevated morbidity and mortality after an index myocardial infarction (MI), but as an independent risk factor in the development of atherosclerotic heart disease. Major depression and depressive symptoms are considerably more common in patients with a variety of medical illnesses than in individuals in the general population. Indeed, receiving a diagnosis of a serious, life-threatening illness often results in a cascade of emotional responses, including feelings of sadness, shock, disbelief, anxiety, or a myriad of other emotional responses.