Psychiatrists have long been working on how to mend a broken heart. Cardiologists have, too.
These days they're comparing notes. So are a host of other specialists. That's because the chronic sadness known as depression could wreak havoc not just on the heart, but throughout the body. Depression may help raise blood pressure. Predict stroke risk. Jostle the immune system. Complicate asthma. Contribute to erectile dysfunction, or rheumatoid arthritis, or osteoporosis.
Research suggests that depression may not just be a psychological spinoff of the stresses of such bodily ailments. In some cases, it may be a physiological warning sign - or even an accomplice.
"Depression afflicts 10 [percent] to 15 percent of the population in the course of a year," says Dr. Michael Irwin of the Neuropsychiatric Institute at the University of California, Los Angeles. "This is not a small problem."
Consider heart patients. Scientists have noted that people who have had a heart attack are more likely to die within months if they also have depressive symptoms; the finding holds even when studies account for other risk factors. Moreover, research on people showing no signs of heart disease has found that depression itself is a sign that heart disease is likely to arise later.
Depression is a systemic illness, not just a mental one, Irwin says. "And the sooner the government and the health-care industry recognize that and provide treatment for depression, the lower the costs for other medical disorders will be."
Sorting out the interaction of depression and other ailments is tricky. A serious illness could, of course, be the root of someone's depression. But in some cases, depression may be abetting the other illness. Or the depression may result from a treatment for the other illness. Perhaps even a common biological factor underlies both.
Cancer risk may be influenced by depression, some studies have suggested, but the scientific verdict is far from in.
Results of earlier studies have been inconsistent; more recent work has suggested that depression may indeed have an association with cancer. One 1998 study, of some 4,800 people 71 and older, found that those with chronic depression were 88 percent more likely to develop cancer, even when scientists accounted for factors such as age, disability, hospitalizations and alcohol and tobacco use. The study appeared in the Journal of the National Cancer Institute.
This subject has long been a federal priority, says Peter Muehrer, chief of the Co-Morbidity Research Program (which looks at diseases that occur together) at the National Institute of Mental Health. Among people with an array of medical problems, including heart disease, diabetes and asthma, many suffer from depression or anxiety disorders, he says.
"Obviously, to treat these people, we have to treat the whole problem."
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