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The Depression-Heart Disease Link

According to the World Health Organization, depression is a worldwide problem that affects an estimated 350 million people. Not only that, depressive disorders are among the most common psychiatric problems in people who have coronary artery disease (CAD)—the most common type of heart disease.

It’s such a concern that the American Heart Association has been urged to elevate depression to the status of “official risk factor for adverse medical outcomes” in patients with heart disease.1 And it’s not just heart patients who are at risk of negative outcomes due to depression. Studies have also found higher risk of illness and death among physically healthy people who develop depression.

Given all this, a recent study published in December 2015 aimed to assess whether depression and/or anxiety raise the risk of all-cause mortality and major cardiovascular events in participants with and without CAD.2

The researchers followed 2,390 patients at the Montreal Heart Institute for 8.8 years. The patients underwent testing for CAD and psychiatric assessments, and had data collected on other risk factors for disease (smoking, presence of high cholesterol or diabetes, use of medications, body mass index, etc.).

During the observation period, 721 people had at least one major cardiac event, and 165 died—48 percent of deaths were due to cancer, while 32 percent were due to cardiac causes.

Participants who suffered from depressive disorder at the start of the study were more than three times more likely to die compared to patients who had no history of depression. However, there was no link between anxiety disorders and mortality among people with or without CAD.

When results were examined based on CAD status, they revealed a link between depression and all-cause mortality only in those who did not have CAD. Among participants without CAD, those who had depression were four times more likely to die than non-depressed participants. In contrast, patients who had CAD and depression were not at an increased risk of mortality compared to non-depressed counterparts.

What could explain these findings?

According to the researchers, CAD patients often are involved in extensive treatment programs that focus on both physical and mental health. So depression can be treated before it worsens or turns into a bigger concern.

In contrast, unlike CAD patients, physically healthy patients who suffer from depression usually are not under the constant care and supervision of a medical team. Decreased motivation and lack of desire to take care of oneself are hallmark symptoms of depression, and these behaviors can lead to dangerous lifestyle choices (smoking, excessive drinking, poor diet and physical inactivity).

These habits, as you know, dramatically raise the risk of serious, and potentially deadly, diseases, including obesity, cancer and CAD. The researchers also noted that depression may cause physiological changes (inflammation and endothelial dysfunction, to name a few) that elevate risk of fatal diseases.

As for the lack of connection between CAD and anxiety, the researchers explain that people with anxiety are actually less likely to engage in risky behaviors that can lead to early demise (such as smoking, heavy alcohol consumption, refusal to comply with medical treatments or regimens, etc.). Interestingly, anxiety sufferers tend to be proactive and vigilant when it comes to taking care of themselves, possibly because they are hypersensitive to even small bodily changes. As a result, they may seek out medical treatment more often and follow through with doctor’s orders.

Natural Depression Treatments

Whether or not you currently have heart problems, one thing is clear: Depression is not to be taken lightly. It is a serious condition that should not be swept under the rug or “dulled” with smoking, excessive drinking, binge eating or other destructive behaviors.

Up to 75 percent of people with depression start using some type of antidepressant, the most common of which are selective serotonin reuptake inhibitors (SSRIs). But more and more research is showing that these drugs are barely effective in the vast majority of users. One study reported, “Meta-analyses of FDA trials suggest that antidepressants are only marginally efficacious compared to placebos and document profound publication bias that inflates their apparent efficacy.”3

Even worse, antidepressants carry a lot of risk. All of these drugs have “black box” labels warning patients that the drugs may increase the risk of suicidal thoughts and behaviors in children and young adults. Other serious side effects include (ironically) worsening depression, anxiety, panic attacks, irritability and hostility, as well as physical symptoms such as insomnia, nausea, dizziness and diarrhea.

Given the risks versus benefits, if you are dealing with depression, antidepressants should be your last resort. The first thing you need to do is seek out a psychologist or therapist experienced in treating mood disorders. Research indicates that cognitive behavioral therapy and interpersonal therapy are two very effective options.4

If you and/or your medical team find you need additional help, before turning to antidepressants, consider trying herbs or nutrients that elevate mood naturally. Some that are backed by solid research include St. John’s wort, SAM-e, omega-3 fatty acids and folic acid.5-7


  1. Lichtman JH, et al. Circulation. 2014 Mar 25;129(12):1350-69.
  2. Pelletier R, et al. BMJ Open. 2015 Dec 15;5(12):e006582.
  3. Pigott HE, et al. Psychother Psychosom. 2010;79:267-79.
  4. Psychology Today. https://www.psychologytoday.com/blog/demystifying-psychiatry/201101/how-many-people-are-treated-depression.
  5. Martins JG. J Am Coll Nutr. 2009 Oct;28(5):525-42.
  6. Mischoulon D and Fava M. Am J Clin Nutr. 2002 Nov;76(5):1158S-61S.
  7. Targum SD and Mischoulon D. Psychiatry (Edgmont). 2009 Sep;6(9):46-8.

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