Depression, Anxiety Bad for the Heart

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"This is something many cardiologists tend not to be comfortable with," Sullivan said, so another physician could be called in to handle the problem. Referral to a psychiatrist is not necessary, because "at this point in time most primary-care physicians are comfortable with making an initial trial with treatment," he said.

The new study was not designed to show whether treatment by such measures as antidepressants could relieve chest pain, Sullivan said, but his group is considering such a trial.

Another report in the journal linked depression with poor outcomes for people with both heart failure, the progressive loss of ability to pump blood, and the abnormal heart rhythm called atrial fibrillation.

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"Many studies have shown that depression is a predictor of mortality after a heart attack or in congestive heart failure," said study author Nancy Frasure-Smith, a senior research associate at the Montreal Heart Institute. "Most studies have shown that differences in severity of heart disease between people who are depressed or not depressed do not account for the difference. One hypothesis is that people who are depressed don't get as good treatment for their heart disease."

To test that hypothesis, Frasure-Smith and her colleagues assessed 974 people with heart disease for depression -- which was found in 32 percent of them -- and then assigned them to get either standard medical care or a heightened degree of care.

The study showed that "depression is at least an indicator of patients who are at higher risk of mortality even when given the best care we know how to," Frasure-Smith said.

Nevertheless, the case against extra care for such people is not proven because "there are no trials assessing treatment for depression in people with congestive heart disease and atrial fibrillation," she said. "Newer antidepressants are more effective, and if you give these people extra care, they may get better."

More information

Depression and its treatment are described by the U.S. National Institute of Mental Health.

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