Depression is one of the issues today’s world faces and tries to overcome. Scientists have shown in time that depression leads to serious conditions such as Alzheimer’s disease, heart disease or to pregnant women having preterm deliveries. The World Health Organization released a report last year saying that depression is more harmful to a person’s health than asthma, angina, arthritis or diabetes. People suffering from depression report poorer health than those suffering from the above conditions. Moreover, if they suffer from one of these conditions, depression tends to make them even worse.

In fact, this is the subject of a new study published in the Nov. 26 issue of the Journal of the American Medical Association, which says that for coronary heart disease patients, depression may be associated with worse outcomes, primarily because it tends to curtail physical activity.

The study led by Mary A. Whooley, MD, of the University of California San Francisco and colleagues found that cardiac patients who had symptoms of depression had a 31 percent higher rate of cardiovascular events, such as stroke, heart failure, heart attack, transient ischemic attack and death. It is known that cardiac patients who are depressed are less likely to exercise which increases risk of cardiac events.

The study involved 1,017 heart disease patients, all of them outpatients at clinics in the San Francisco area. They were recruited between 2000 and 2002 and followed until early 2008. The participants were given questionnaires to see whether they had symptoms of depression. The researchers found that 199 of them had these symptoms. Moreover, depression made them more likely to smoke and forget about their medications. Also they were less physically active than the rest of the participants.

When the researchers adjusted for the patients' health behaviors, such as physical inactivity, there was no longer a significant association between heart disease and depression. Physical inactivity was associated with a 44 percent greater rate of cardiovascular events. That’s why doctors should encourage patients with heart disease to get as much exercise as possible in order to avoid cardiac events.

“These findings raise the hypothesis that the increased risk of cardiovascular events associated with depression could potentially by preventable with behavior modification, especially exercise. Exercise training can improve both depressive symptoms and markers for cardiovascular risk,” the study says.

What was unclear in this study was the fact that it could not discern whether depression led to inactivity or if inactivity led to depression. Regardless, the incorporation of exercise into a comprehensive depression treatment plan may be beneficial to many patients who suffer from both depression and heart disease.

The fact that depression might lead to cardiac events in people suffering from heart disease is not something new. That’s why in September this year, the American Heart Association recommended screening for depression in all patients with heart disease. According to the guidelines, cardiac patients should be asked two key questions: “Have you recently felt little or no pleasure in doing things?” and “Are you feeling down, depressed or hopeless?” If patients answer yes to both questions, they should immediately be evaluated further with a second questionnaire of nine items.

Those patients scoring high on the second questionnaire must be referred to a professional qualified in the diagnosis and management of depression. The treatment of depression might include antidepressant drugs, behavior or talk therapy and physical activity.

Sometimes, these patients don’t need medication. A healthy lifestyle including healthy food and physical activity and therapeutic meetings sometimes help. But for those who really need medications, the AHA recommends antidepressants Zoloft and Celexa, as research has shown they are generally safe for cardiac patients.

Moreover, cardiac patients suffering from depression should also be screened for other psychiatric disorders, such as anxiety, which is known to have repercussions on the heart.