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Depression and Cardiac Health: A Disturbing Combination

Neuroaffect Circuit Cardionomic Circuit

By: Michael Lam, MD, MPH; Justin Lam, ABAAHP, FMNM; Carrie Lam, MD

Maybe the fairy tales are right—a broken heart is a tragedy. The American Heart Association certainly agrees. Recent studies have shown a strong connection between depression and cardiac health. The studies looked at two groups of cardiac patients at risk of depression and placed them into either the high-risk or low-risk category. Interestingly, those with a high risk of depression were twice as likely to be hospitalized for other health issues. Also, the studies found high-risk patients also spend more money on healthcare, have a decreased quality of life, and are unhappy with how they perceive their health. Depression really does hurt the heart. And everything else it touches!

Depression Explained

An explination on depression and cardiac healthDepression is quite common, but its prevalence doesn’t mean that it’s correctly diagnosed in every patient. Depression is defined as a mood disorder characterized by feelings of sadness and a loss of interest in activities that persists for more than two weeks. Other symptoms can include:

  • Hopelessness
  • Easily angered
  • Sleeping too much
  • Severe lack of energy
  • Extreme appetite changes
  • Strong feelings of guilt or self-blame
  • Difficulty thinking and speaking
  • Suicidal thoughts

Scientists of Harvard Medical School and Massachusetts General Hospital looked at the correlation between depression and patients with cardiac illness. They found that approximately 50-70% of patients with acute heart problems in the hospital demonstrated depressive-like symptoms that had started before hospitalization. Feelings of anxiety and traumatic stress were also seen to cause significant heart problems in a number of patients.

While in the hospital, if the depression-like symptoms were not addressed successfully, heart patients had an increased risk of readmission. The length of stay in hospital also worsened the risk of depression and cardiac health problems. There is also an increased risk of complications in the operating room and patients reported a decreased quality of life.

Missing Links

Depression is often seen externally, but internally, your body is reacting as well. Sometimes it can be difficult to link a feeling or mood to an internal response, but the links are actually scientific in their origin.

The Inflammation Connection

With depression, pro-inflammatory chemicals called cytokines are increased throughout the body. Cytokines such as C-reactive protein (CRP) and Interleukin-6 (IL-6) are two chemicals that have been proven by scientists to indicate a worsening heart condition or even death. Inflammation was also found to have a neural—or brain—connection via the effects of serotonin. Another cytokine, interferon alpha, was found to be increased during times of excessive fatigue. However, if serotonin levels return to normal, the effects of fatigue and exhaustion are reduced, and inflammation decreases.

Endothelial Help

Within your arteries and veins, the cells lining these blood vessels are called endothelial cells. These cells have specialized receptors that allow them to sense stress. When this happens, they send out signals to help your blood vessels change in size and thickness—to become more narrow or wider. However, if there is inflammation in your blood vessels caused by the build-up of plaque, endothelial cells cannot send out the right signals during times of stress. More importantly, if a piece of plaque becomes loose and blocks the artery and the body is unable send the right signals to make the area bigger, the result can be deadly.

Brain-Derived Neurotrophic Factor

When the brain wants you to do something, it sends out signals via neurons. Brain-derived neurotrophic factor (BDNF)—a protein—helps neurons and cells of your brain grow and make connections. It also helps to moderate the production of cytokines that can damage your brain’s ability to heal and continue to make new cells. When inflammation increases, BDNF decreases and these low levels can bring about depression-like symptoms.

Although this technically occurs in the brain, it can affect other areas throughout your body. One specific function of BDNF is to help your heart survive and pump at a reasonable blood pressure if your heart is suddenly compromised.

Worsening Behavior

Depression and cardiac health behaviorAs bad as these internal activities may seem, at the same time the psychological effects of healing are not always positive. Occasionally, heart problems can worsen depression. Think about it. When you’re sick, your natural impulse is to eat comfort foods that are rich in carbohydrates, sugars, fats, and unhealthy proteins—like fried chicken, mashed potatoes, milk-gravy, and fried okra, all served with a large glass of iced tea and Grandma’s triple-chocolate cake for dessert. Of course, we all know this isn’t healthy, but it seems to be the widespread response after being discharged from the hospital.

Other unhealthy behaviors include not taking medication as advised, refusing to exercise, not participating in heart-rehabilitation programs, or not reducing stress levels. Even though you were sent home from the hospital to heal, all of these behaviors actually worsen your depression and cardiac health.

Responding to Stress and Adrenal Fatigue

Before there are any outward signs of depression and cardiac health problems, there is, in fact, an initial stressor or multiple stressors that may not have been dealt with correctly by your body. To start at the very beginning, when your body is placed under stress, a highly specialized cascade of events occurs. You won’t even know it’s happening since your body does this quietly and efficiently. More specifically, your NeuroEndoMetabolic Stress response (NEM) begins to work in a variety of different ways.

Stress Response

To deal with the stress caused by depression and cardiac health issues, your Cardionomic circuit sends signals to your adrenal glands, cardiovascular system (heart, arteries, and veins), and autonomic nervous system to produce certain hormones. These stimulate changes in your body in order to deal with stress. If this begins to fail, early symptoms may show up such as low blood sugar levels, inability to exercise, sugar cravings, and tiredness. As the stress worsens, your heart will begin to beat faster, postural problems and dizziness (from standing up quickly) can occur, and you may be unable to sleep.

Sometimes, only one circuit of the NEM system is needed to return your body to normal stress levels. Other times, however, additional help is needed.

The Neuroaffect circuit response is characterized by your body releasing certain chemicals such as epinephrine and serotonin. Epinephrine, also known as adrenaline, is responsible for the fight-or-flight response. Adrenaline is produced whenever there is a perceived danger to your survival and results in a sudden increase in blood pressure and increased heart rate to help protect your body.

On the other hand, serotonin can relieve symptoms of anger and aggression. The feel-good hormone, as it is known, may also change your body temperature, increase your sexual drive, and improve your sleep and mood. If your body begins to run out of serotonin due to repeatedly high levels of stress, your body may respond with worsening symptoms.

Adrenal Fatigue Syndrome

Adrenal Fatigue Syndrome, depression and cardiac healthAs much as you may hope your body has a never-ending supply of feel-good hormones and neurotransmitters, it’s important to remember that it doesn’t. When these stores begin to run out, the symptoms of Adrenal Fatigue Syndrome (AFS) may begin to show. Adrenal Fatigue is not defined by one symptom but many, triggered by a tired body that is no longer able to cope with stress. Symptoms usually start out as vague discomforts that progressively become more exaggerated. Feelings of anxiety with impending doom and severe exhaustion are just some of the symptoms that occur. Your body will gradually try to slow down any processes that aren’t critical to sustaining life. At this stage, you’ll become bedridden and need help just to walk. Eventually, without proper care, AFS can be fatal.

How Can You Avoid Worsening Your Depression and Cardiac Health?

The best and most natural thing to do is start with the basics. If you can find the cause of your depression, then you should be able find appropriate care. Seeking psychological help is essential and talking with a therapist to work through any mental stress you may be facing can help. Other ways to bring calm into your life include meditation, reading, arts and crafts like knitting or pottery, or simply listening to some calming music.

In addition, a quality diet filled with plenty of fruits, vegetables, healthy fats and oils, and lean protein are excellent ways to improve your cardiac health. If you’re a smoker, it’s strongly encouraged to stop. Also, exercise has been shown to help depression and at the same time improve heart health. Whether it’s a gentle walk around the block, signing up for a 5k run, practicing yoga, or swimming at your community center, even a small amount of consistent exercise can help heal both your body and mind.


His flawed heart – alack, too weak the conflict to support – twixt the extremes of passion, joy and grief, burst smilingly


depression and cardiac health reliefAs the tragic tale of King Lear has taught us, not addressing depression can be fatal. No, your heart may not burst in an explosive death, but it can stop working effectively due to the effects of depression. Numerous studies have looked at the link between depression and cardiac health, and there was one consistent outcome—when depression is dealt with effectively, the likelihood of increasing your overall health is extremely high. So, if you find yourself suffering from depression-like symptoms, get help today. You don’t have to suffer alone and in silence. Help is always available.

© Copyright 2018 Michael Lam, M.D. All Rights Reserved.

Dr. Lam's Key Question

Good psychological help is essential to improving your depression and cardiac health. Talking with a therapist to work through any mental stress you may be facing could help you immensely. Other ways to bring calm into your life include meditation, a healthy diet, and gentle consistent exercise.

depression and cardiac health

© Copyright 2001-2021 Michael Lam, M.D. All Rights Reserved.
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