A new UCLA imaging study reveals significant brain damage in heart failure patients. The damage lowers patients' quality of life and could dramatically alter their ability to exercise, which is crucial to recovery. The damage occurs in areas of the brain that regulate the autonomic nervous system, thus interfering with the cardiovascular system's ability to swiftly adapt to changes in blood pressure and heart rate.
The damage also lies in the same brain areas that display changes in people suffering from major depression, helping to explain why many heart failure patients are often depressed.
These findings come on the heels of several important studies this year that shed light on the relationship of depression to heart disease:
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A recent study proved that even mild depression can lead to heart failure.Medical researchers have long understood that people with heart disease were more likely to suffer from depression, and that major depression could lead to heart problems. However, this new study, from the Duke Medical Center, reveals that symptoms of depression often considered insignificant can indicate a condition that can damage the heart. See Depression and Heart Attack and Depression and Heart Failure.
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Another group of Duke University Medical Center researchers have found that patients using SSRIs prior to undergoing coronary artery bypass surgery have significantly higher death and rehospitalization rates up to five years after the procedure than patients who were not on SSRIs. See Heart Surgery and SSRIs.
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This is likely to be due to the fact that SSRIs, though they can be effective in treating depression and anxiety, fail to lower cortisol levels. That means that a doctor treating a heart disease patient who is depressed may succeed at alleviating the depression by prescribing an SSRI... but that dangerous levels of cortisol may continue to deplete the heart muscle.
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Another recent study revealed that people with mild depression were six times more likely to develop major depression, which creates an even greater risk of Metabolic Syndrome and heart disease.
Clearly, the links between heart disease and depression are multiple as well as lethal. The feedback loops go both ways.
The implications for medical care are also multiple. Clinically, the findings emphasize the need for (1) cardiologists to recognize that heart failure patients suffer from a genuine brain injury, as well as a heart injury, and (2) that drugs or other therapies must be developed to cross the blood-brain barrier, prevent brain injury and boost brain function. Also, heart patients on antidepressants need to be monitored for cortisol levels.
The UCLA research appears in the August edition of the Journal of Cardiac Failure, Vol. 11, No. 6.
