What’s Heart Got To Do With It?
By Dr. Ben Goldstein
On August 11th, the leading journal in cardiology, named Circulation, published an article titled Major Depressive Disorder and Bipolar Disorder Predispose Youth to Accelerated Atherosclerosis and Early Cardiovascular Disease: A Scientific Statement From the American Heart Association.* I had the honour and privilege of being the lead author on this article, which was the product of a collaborative effort that included epidemiologists, pediatricians, preventive cardiologists, health psychologists, psychiatrists, and a community member representing the patient perspective. Heart disease and mood disorders? In teens? As the kids are saying these days, “Wait, what?!”
What’s in the article?
In 2011, a landmark article identified several medical conditions that put youth at increased risk for heart disease. In our recent article, we established that major depressive disorder and bipolar disorder should be added to the list of moderate-risk conditions. We concluded this on the basis of a series of prior studies that showed these disorders are linked with premature problems with blood vessel structure and function, premature heart disease, and even premature death from heart disease.
In one study that included 7000 young adults (<30 years old) in the U.S., depression was the leading predictor of death from heart disease among women, and the 4th leading cause in men. The article also highlights that the connection between mood disorders and early heart disease is independent of the effect of lifestyle, traditional heart disease risk factors, and/or medications. This statement from the American Heart Association advises more assertive heart health-related screening and treatment when dealing with teens who have mood disorders.
Why does this matter?
Well, it matters for three main reasons. First, the article tells us that we need to take the physical health of teens with mood disorders very seriously. “We” includes all of us. Psychiatrists, pediatricians, cardiologists, patients, families, policy-makers, and the public. Symptoms of depression and mania are very impairing and draw a lot of clinical attention – but they can’t distract us from looking at global health of affected teens, including mental and physical health. Reducing the rate, and delaying the onset of, heart disease has the potential to save and extend lives of these youth.
Second, improved physical health can have important ramifications for mental health. Other blog posts attest to the therapeutic potential of exercise on mood symptoms (and anxiety, and cognitive ability). In addition, heart disease risk factors such as obesity and diabetes are known to reduce the response to mood disorder treatments. Improving physical health for teens with mood disorders could potentially increase their response to treatment.
Finally, although there have been improvements in recent years, there is still a lot of stigma that needs to be erased. By showing that mood disorders are related to heart health, and perhaps caused by the same factors, this statement serves as a powerful anti-stigma document.
Mood disorders among youth are generally not caused by poor physical health, and improving physical health is generally not going to be enough to treat mood disorders. But, when combined with evidence-based treatments (therapy and medications), focusing on heart offers a trifecta of benefits for teens with mood disorders: better physical health, better mental health, and less shame about having a mood disorder.
* The paper is publicly available at http://circ.ahajournals.org/content/early/2015/08/10/CIR.0000000000000229.long
Dr. Benjamin Goldstein is a psychiatrist and Director of the Centre for Youth Bipolar Disorder at Sunnybrook. He is an international expert on the overlap between bipolar disorder and physical health.