Therapy for Depression Reduces Cardiovascular Risk

According to new research published today in the European Heart Journal, effective depression management through psychological therapy is related to a lower risk of heart disease and stroke.

“Our study suggests that improving mental health could also help physical health, especially in those aged under 60,” said study author Céline El Baou, a Ph.D. student at University College London, UK. People whose depression symptoms improved after therapy had a 10% to 15% lower risk of cardiovascular disease than those who did not improve. Comparable effects were found in similar studies investigating low-fat diets.”

Globally, cardiovascular disease is the major cause of death. In 2019, over 523 million people have cardiovascular disease. People with significant depressive disorders have a 72% greater risk of cardiovascular disease than their healthy colleagues.

This was the first study to look into whether lowering depressive symptoms with psychological therapy is linked to a lower risk of developing cardiovascular disease in the future. The study included 636,955 persons over the age of 45 who were depressed and had finished a term of psychological therapy but did not have cardiovascular disease or dementia. The average age was 55, and 66% of the participants were female. Individual-level data on psychological treatment, the incidence of cardiovascular illness, and death were acquired from national electronic health record databases in England.

The Patient Health Questionnaire-9 (PHQ-9) was used to assess depression levels before and after therapy. The PHQ-9 assigns a score of 0 (not at all) to 3 (nearly every day) to nine items, including little interest or pleasure in doing things; feeling down, depressed, or hopeless; trouble falling or staying asleep, or sleeping too much; feeling tired or having little energy; poor appetite or overeating; feeling you are a failure or have let yourself or your family down; A score of ten or higher indicated depression.

Improvement in depression was defined as a PHQ-9 score drop of 6 points or more and no worsening of anxiety (defined as an increase of 4 points or more on the Generalized Anxiety Disorder scale) between the beginning and end of treatment. Anxiety was included in the criteria so that if depression improved but anxiety worsened, the outcome of therapy was not considered positive.

Patients were monitored to see if they developed new all-cause cardiovascular disease, coronary heart disease, stroke, or died from any reason. Follow-up began 365 days following the last therapy session, and those who experienced a cardiovascular event during this time were eliminated to limit the possibility that previously undiscovered disease was the cause of depression.

During a median follow-up of 3.1 years, depression symptoms improved in 373,623 (59%) participants and did not improve in 263,332 (41%). There were 49,803 cardiovascular events and 14,125 participants died.

Compared to no change, depression improvement was related to 12%, 11%, 12%, and 19% decreased chances of any cardiovascular disease, coronary heart disease, stroke, and all-cause mortality, respectively. Age, ethnicity, gender, socioeconomic deprivation, and other health factors were all taken into account when the studies were conducted.

All of the relationships were higher in people aged 45 to 60, with depression treatment associated with a 15% reduction in the risk of cardiovascular disease compared to no change; the corresponding figure for those aged 60 and above was 6%. Furthermore, 45 to 60-year-olds with improved depression had a 22% lower risk of death during follow-up compared to those who did not improve, while those 60 and older had a 15% reduction.

El Baou said, “The findings are consistent with previous research suggesting that interventions to modify risk factors for cardiovascular disease are more effective at a younger age. This highlights the value of receiving help early to gain the most benefit.”

The authors noted that the results do not definitively prove that reductions in cardiovascular disease were caused by relief of depression. In addition, data were missing on lifestyle behaviors such as smoking and inactivity which could raise susceptibility to cardiovascular disease and limit the effect of psychological treatment.

El Baou said, “Our findings emphasize the importance of making psychological treatments more widely available and accessible to enhance mental and physical health. This is especially relevant for certain groups who face barriers to accessing psychological therapies and are at greater risk of cardiovascular disease. Collaborative care systems where specialists from both disciplines work together could be one way to make treatment more accessible and obtain better outcomes overall.”

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