Facts

• Even mild forms of depression or depressive symptoms increase heart disease risk.[1]
• The exact relationship between CVD and depression is not clear, but it is no longer believed that the development of depressed mood after a CVD event is simply a "normal' response to illness. [1]
• Depression is twice as common in women as in men, and increases the risk of heart disease by two to three times compared with women who are not depressed regardless of race, ethnicity or economic background.[2]
• Depression makes it difficult for women to maintain a healthy lifestyle and to follow recommended treatment. [2]
• A recent study of 63,469 women found that depressive symptoms were associated with an increased risk of fatal coronary heart disease in relatively healthy women with no prior coronary heart disease.[3]
• Depression can lead to heart disease in women and results in those women being more than twice as likely to experience sudden cardiac death.[3]
• Depression impedes recovery and ultimately quality of life in women patients following a heart event.[4]
• The Women's Health Initiative study showed that women who did not exercise regularly, had high blood pressure or diabetes, and who reported fair or poor health were more likely to be depressed.[5]
• Women with a history of angina are 57% more likely to suffer from depression than women without any history of heart disease.[5]
• The Women's Ischemia Syndrome Evaluation (WISE) study found that women with higher levels of depression were the most likely to be obese, smoke, or to have unhealthy cholesterol levels – all recognized risk factors for coronary artery disease.[6]

Early Detection

• Women are less likely to be referred to cardiac rehabilitation, therefore not having access to support and assistance in making lifestyle changes that are necessary for recovery after a heart attack.[4]
• Depression is difficult to diagnose in women with CVD and other medical illnesses due to sometimes atypical depression symptoms and the the many physical symptoms that accompany heart disease.[1]
• The difficulty in diagnosing depression in women with cardiovascular disease is compounded by the fact that cardiovascular health care providers typically have a low awareness of and little focus on mental health issues and neither accurately diagnose nor treat depression in the vast majority of CVD patients they care for.[1]

Accurate Diagnosis

• Several depression screening tools are widely available and easy to use (BDI, PHQ-9, PHQ-2), and despite their limitations, should be used routinely to assess women with CVD in order to improve diagnosis and treatment rates.[1]

Proper Treatment

• Comprehensive cardiac rehabilitation programs and regular physical activity are strongly associated with both lower depression levels and CVD morbidity and mortality and should be strongly recommended to women with CVD, especially those with depression.[1]
• Women appear to respond differently compared to men to psychosocial interventions such as counseling and cognitive behavioral therapy for depression and low social support after MI.[1]
• SSRIs may favorably impact CVD risk by modifying adverse physiologic conditions (e.g., thrombotic potential, abnormal heart rate variability) and by improving mood enough to adopt healthy lifestyle behaviors and adhere to treatment recommendations.[1]
• Sertraline (ZOLOFT®) and citalopram (Celexa®) are the preferred first-line antidepressants for women with coronary heart disease since they have acceptable safety, tolerability, and limited interaction with commonly used cardiac medications. Tricyclic antidepressants should generally be avoided due to increased cardiac risk.[1]

1. Hayes, Sharonne N., M.D.  Broken-Hearted Women: The Complex Relationship Between Depression and Cardiovascular Disease.  Mayo Clinic College of Medicine. Rochester, MN. 2009.

2. Mayo Clinic staff, et al. Heart disease in women: Understand symptoms and risk factors. 2009. Mayo Foundation for Medical Education and Research (MFMER). Rochester, MN; 1998-2009. http://www.MayoClinic.com/health/heart-disease/HB00040. Accessed August 5, 2009.

3. Wellsphere. Depression and Coronary Heart Disease in Women. 2009. http://www.wellsphere.com/mental-health-article/depression-and-coronary-heart-disease-in-women. Accessed August 5, 2009.

4. Medindia Health Network Pvt Ltd. Women with Heart Disease Suffers from Depression. 2007. http://www.medindia.net/news. Accessed August 5, 2009.

5. Wassertheil-Smoller, S., Shumaker, S., et al. "Depression and Cardiovascular Sequelae in Postmenopausal Women: the Women's Health Initiative (WHI). Arch Intern Med 2004; 164:289-98. PubMed

6. Rutledge,T, et al. "Psychosocial Variables are Associated with Atherosclerosis Risk Factors Among Women with Chest Pain: the WISE [Women's Ischemia Syndrome Evaluation] Study."  Psychosom Med 2001; 63:282-288. PubMed