Omega-3 may help depressed heart attack patient

Researchers at Washington University are speculating that omega-3 fatty acids may help depressed heart attack patients live a longer, healthier life.

Sound fishy? It should. Omega-3s are found in some types of fish oil and have long been thought to improve several risk factors for heart disease. Now, doctors are studying whether, when combined with antidepressants, they can improve the longevity of certain heart attack patients.

The research comes on the heels of a report that sheds new light on the link between depression and heart attack deaths. For years, doctors have known that depression increases the risk of dying in the months after a heart attack, but have been unable to explain why.

Now, they think they have at least a partial answer: Depression seems to affect the heart's ability to adjust to a body's demands -- a phenomenon known as abnormal heart rate variability.

As a result, doctors say treatments that alleviate both depression and the abnormal variability may offer the best hope to improve survival among depressed patients with coronary artery disease. The work was published in a recent issue of the Archives of Internal Medicine.

The researchers studied 311 depressed heart attack patients who participated in the Enhancing Recovery in Coronary Disease (ENRICHD) study and compared them to 367 non-depressed heart patients. Patients were followed for about 2 1/2 years.

"Depressed patients were nearly three times as likely to die during the study period as comparable, non-depressed heart patients," said Dr. Robert M. Carney, professor of psychiatry and the principal investigator. "We also found that lower heart rate variability was responsible for a sizable portion of that risk."

Heart rate variability measures how the heart adjusts to varying levels of demand -- exercise or stress, for example. In people with low heart rate variability, the heart doesn't adjust as quickly as needed.

"We have known for some time that depression increases the risk of death from heart disease, but we didn't know why depressed patients were more likely to die and whether heart rate variability had anything to do with the risk," Carney said. "This study shows it does account for at least a portion of the increased risk."

The work led directly to Carney's new study: Seeing whether a combination of omega-3 fatty acids and antidepressants can lower the risk of death. To improve the odds, Carney and his colleagues are using a special formula of omega-3s not found in health stores that they hope will help both depression and the heart.

"Omega-3 is an essential fatty acid, which means we have to get it from the diet," Carney said. "We know it improves a variety of cardiac risk factors, and studies have suggested it also might improve heart rate variability.

"There's even some indication that our special formulation might be helpful for depression, so we're very excited about its potential to help heart patients with depression."

Carney will follow depressed heart patients for 12 weeks. All will receive antidepressant drugs, but only half will receive the omega-3 supplement while the other half will receive a sugar pill.

"We think omega-3 might make cells a little more receptive to antidepressant medications," Carney said. "If that's the case, these medications might have a greater impact, both in improving depression and in reducing risk of future cardiac problems."

Interestingly enough, the study found that the risk of death increased over time with depressed patients at greater risk more than a year after their heart attack.

"Cardiologists do a very good job keeping people alive and getting them back on their feet after a heart attack," Carney said. "But in the months after a heart attack, people aren't followed as closely, and many stop taking some of their medications regularly. That's when depression seems to have its most negative effect."

That's why, in addition to heart rate variability, researchers need to look at other ways in which depression increases the risk of death after a heart attack, Carney said. For more information on the new omega-3 study, contact coordinator Cathi Mueller at (877) 717-0757.

Contact reporter Roger Schlueter at 239-2465 or rschlueter@bnd.com

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