Study Links Depression in Women to Sudden Cardiac Death

NEW YORK–Researchers at Columbia University Medical Center and Brigham and Women’s Hospital in Boston have found a strong correlation between depressive symptoms and cardiac events in women

New data published in the March 9, 2009, issue of the Journal of the American College of Cardiology suggest that relatively healthy women with severe depression are at increased risk of cardiac events, including sudden cardiac death (SCD) and fatal coronary heart disease (CHD).

William Whang, M.D.

A team led by William Whang, M.D., of the cardiology division at Columbia University Medical Center, found that much of the relationship between depressive symptoms and cardiac events was mediated by cardiovascular disease risk factors, such as high blood pressure, high cholesterol and smoking.

Dr. Whang and his colleagues prospectively studied 63,469 women from the Nurses Health Study who had no evidence of prior heart disease or stroke during follow-up between 1992 and 2004. Self-reported symptoms of depression and use of antidepressant medication were used as measures of depression. To best identify those with clinical depression, researchers specifically examined women with the most severe symptoms defined by a validated 5-point mental health index score or regular antidepressant use.

The study found that women with more severe depressive symptoms or those who reported taking antidepressants were at higher risk for SCD and fatal CHD. In particular, women with clinical depression were more than twice as likely to experience sudden cardiac death. Surprisingly, this risk was associated more strongly with antidepressant use than with depressive symptoms.

Dr. Whang stresses that although the relationship between antidepressant medicines and SCD merits further investigation to determine whether antidepressant medications directly increase the risk for heart rhythm disorders, at present the benefits of appropriately prescribed antidepressants outweigh the risk of sudden cardiac death.

"We can’t say antidepressant medications were the cause of higher risk of sudden cardiac death. It may well be that use of antidepressants is a marker for worse depression,” Dr. Whang said. “Our data raise more questions about the mechanisms by which depression is associated with arrhythmia and cardiac death."

Overall, the study findings reinforce the need for patients with depression to be monitored closely for risk factors for coronary heart disease, Dr. Whang said, since management of these risk factors can reduce the risk for mortality from coronary heart disease and sudden cardiac death.

"It’s important for women with depression to be aware of the possible association between depression and heart disease, and work with their health care providers to manage their risk for coronary heart disease," he said.