Study: Depression Can Exacerbate Heart Failure

Depression may promote stiffening of the heart tissue, which worsens heart failure, a study reports today.

Though there has been strong evidence that depression can lead to higher death rates from coronary heart disease, there has been less research on how symptoms of depression affect the health of people with heart failure.

The worse someone’s symptoms of depression, the stiffer his heart tissue appears to be in the new study of 880 adults by researchers from University of Maryland School of Medicine. The team will report the results today at the American Psychosomatic Society meeting in Baltimore.

A healthy heart expands and contracts like a rubber band. But when heart tissue stiffens, a process called fibrosis, the heart becomes inflexible and can’t pump blood as well.

In the study, researchers measured proteins in the blood that indicate stiffening of heart tissue. They also checked for C-reactive protein, another protein in the blood that is linked to inflammation.

They found that inflammation played a key role in explaining why depressed adults have stiffer heart tissue. Depressed adults had higher levels of this C-reactive protein and more inflammation.

Inflammation stimulates the production of collagen, and too much collagen stiffens the heart, says psychologist Emily Kuhl, who did the study with co-author Willem Kop.

"It’s like an extra knock against you, if you’re depressed," Kohl says, "because it may put you at risk for collagen deposits that worsen heart failure."

It’s difficult to sort out cause and effect, though, says Karina Davidson, a health psychologist and expert in cardiovascular disease at Columbia University College of Physicians and Surgeons.

Growing evidence suggests inflammation also can promote depression, as well as depression leading to inflamed tissue. "Still, if depression accelerates this inflammation, it could worsen the prognosis of someone with heart failure," she says.

Depression also could lead to an earlier death because depressed people are less likely to take their medication, exercise or quit smoking, she says.

Many safe antidepressants don’t interact badly with heart failure drugs, says Davidson, and therapy also can help. There’s no proof that treatment for depression will extend the life span of someone with heart failure, but it can improve quality of life, she says.

"We see a lot of people with heart failure and depression," says David Sheps, associate chief of cardiology at University of Florida Department of Medicine. The new findings are interesting but need to be replicated by other studies, Sheps says.

The older an adult, the more common heart failure is, but it’s not uncommon in patients in their 40s and 50s, Sheps says. The number of Americans who have heart failure is bound to increase, he says, as the population ages.