Sad hearts are bad hearts

The saying that laughter is the best medicine may have garnered some legitimacy in a new medical discovery related to heart failure. Psychiatrists and cardiologists at both the UC Davis and Duke University schools of medicine have found that controlling depression in patients can lead to better success in their treatment of heart disease.

Heart failure is characterized by the heart’s decreasing ability to pump blood. This condition has been well-studied so there are very advanced treatments for this issue, but those treatments do not include treating depression simultaneously. This the first study showing that reducing the symptoms of poor mental health can directly be connected to the improvement of physical health.

Glen Xiong, associate clinical professor of psychiatry and behavioral sciences at UC Davis and the study’s lead author, used secondary analysis on data that came from the 2008 Sertraline Against Depression and Heart Disease in Chronic Heart Failure (SADHART-CHF). Using this data, Xiong and his colleagues were able to find the connection between heart disease and depression. The focus of the SADHART-CHF trial was the antidepressant medication sertraline and its ability to reduce depression and cardiac symptoms in men and women 45 years of age or older.

Over the course of the 12-week SADHART-CHF study, standardized evaluations were administered with the purpose of measuring both depression and the general health of patients. The Hamilton Depression Rating Scale questionnaire was used to measure the severity of the depression symptoms in heart patients, and the Kansas City Cardiomyopathy Questionnaire and the Short Form Health Survey were used to determine cardiac and general health.

Surprisingly, the initial results found that sertraline did not differ from a placebo in the effectiveness of reducing depressive symptoms.

“The placebo effect is powerful … knowing that there is a possibility of getting better can help reduce feelings of hopelessness, initiating a cascade of improvements,” said Dorje Jennette,
 coordinator of the Stress and Wellness Clinic at UC Davis.

Therefore, the current study will differ from SADHART-CHF in that it will focus on participants’ depression and health status, independent of medication.

The question remains, however, whether it is the improved mental health or the improved physical health that more directly affects the patient. Researchers are looking to see if it is improving the psychological situation that makes the patients feel better emotionally or if it is that the patient’s body is able to focus more on the heart problems and physical improvement.

This is a very complicated idea to try to decipher, and medical professionals have yet to reach a consensus. Xiong believes that the poor health of patients was caused by both poor mental and physical health, and therefore the healing process was caused by mending both the mind and body. Body and mind are difficult to separate, and this research shows that by improving the health of one, you improve the health of the other.

“Our new study is just the tip of the iceberg, since the relationship between the body and mind is extremely complex,” said Wei Jiang, senior author of the study and director of the Neuropsychocardiology Laboratory at Duke University Medical Center.

Xiong hopes that with this study now proving there is a connection between mental health and heart health, cardiologists and other physicians may be more likely to screen patients for depression before deciding on a treatment for chronic diseases, especially chronic cardiac diseases. By screening for depression, the physician is more prepared to treat all issues with his patients.

The study is available in the print issue of Circulation: Heart Failure released Wednesday.

KELLY MITCHELL can be reached at science@theaggie.org.

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