The relation between depression and heart diseases is a matter of public interest as well as scientific research. The negative impact of depression is particularly well documented in the course of ischemic heart disease, also called coronary artery disease, which is caused mainly by atherosclerosis. The best known form of ischemic disease is a heart attack, which may be the first manifestation of the disease, while posing immediate threats to life at the same time. Heart attack promotes the appearance of depression, at the same time, depression is conductive to the occurrence of ischemic heart disease. The severity of the abnormality in one condition exacerbates the symptoms in the other.
Depression as the underlying cause of myocardial infarction
Depression is known to increase the risk of ischemic heart disease, exacerbate cardiac disease and increase the risk of cardiac death. Depressive disorders may adversely affect the cardiovascular system. Although the pathomechanism of the impact of depression on the condition of the heart is not unambiguous and is still subject to discussions in the subject literature, the following mechanisms are considered:
- Behavioural changes. We observed a drop in care for the overall health in depression. Patients with depression are less physically active, have poor nutrition, tend to smoke and exhibit other behaviours that increase the risk of heart disease. Both the prevention and treatment of ischaemic heart disease presupposes adherence to a healthy diet, appropriate physical activity and the use of prescribed drugs. Passive attitude of people with depression is not conducive to maintaining their health
- Increased platelet aggregation. In people with depression, there is an increase in the activity of platelets, which causes their gluing and occlusion of coronary vessels. This can lead to dangerous blood clots and blockages of blood flow. Higher blood clotting disturbs the perfusion (blood flow) in the heart muscle. Platelet aggregation is exacerbated by stress.
- Inflammatory condition. People with depression have higher levels of pro-inflammatory cytokines. These compounds lead to the development of an inflammatory process in the walls of blood vessels and accelerate the formation of atherosclerosis. Increased inflammatory processes within the vessels lead to destabilization of the atherosclerotic plaque. Unstable coronary plaque means risk of thrombosis and myocardial infarction. Sudden and prolonged stress leads to the development of inflammation in the vessel walls.
- Disorders in the autonomic system. People with depression demonstrate disturbed, inharmonious functioning of the autonomic nervous system. In people with depression, there is increased activity of the sympathetic (stimulating) system while reducing the tension of the parasympathetic (inhibiting) system. This adversely affects heart rate variability (HRV) and reduces the value of this indicator. Low HRV may be arrhythmogenic in people with myocardial injuries. HRV analysis helps to assess the functioning of the autonomic system and assess the risk of cardiovascular diseases. High HRV correlates with good health. Relaxation, meditation and exercise increase HRV.
- Mental stress. There is a common mechanism of stress response in the pathogenesis of both depression and ischemic heart disease. Stress is not the only the cause leading to diseases, but it is worth noting that it promotes the emergence of overweight and obesity, hypertension, diabetes, excessive alcohol consumption and smoking. All these factors contribute to the development of ischemic heart disease.
Experts say that depression should be treated as an independent risk factor for cardiovascular disease. Having even one episode of depression in a lifetime increases the likelihood of developing ischemic heart disease, and this even in people without other risk factors.
Myocardial infarction as a cause of depression
The presence of acute coronary episodes, such as heart attacks, increases the risk of depression several-fold. Heart attack constitutes a strong biological and psychological stressor, which is why it harms both the heart and the psyche. The prevalence of depression in people after a heart attack is significant. Clinically significant depressive symptoms occur in up to 45% of patients with coronary artery disease, and their presence is associated with unfavourable cardiac prognosis. Depressive disorders in hospitalized people occur more often in patients with a history of depressive episode. Depression after a heart attack is caused by a psychological reaction to:
- life-threatening condition,
- information about the disease,
- dependence on other people,
- loss of social position.
It was noted that the depressive symptoms in somatic patients tend to progress to a chronic state.
The coincidence of depression and coronary artery disease is cognitively interesting, but above all it should be noted in the daily work of doctors. The diagnosis of depression in people with ischemic heart disease means that additional therapeutic efforts are required, and the treatment of depression must go hand in hand with the treatment of ischemic heart disease. In patients after a heart attack, it is very important to reduce the negative psychological conditions and stress associated with both depression and heart disease. Pharmacotherapy of depression is possible, but caution should be exercised in people who have suffered from a heart attack. In addition, pharmacotherapy will not be effective in developing pro-health behavioural patterns. Psychotherapy demonstrates higher safety in this respect. VR TierOne therapy offers innovative and safe psychological support to cardiac patients.
The therapy apply Virtual Reality to completely separate the patient from the hospital environment, providing an optimal therapeutic environment. The therapeutic cycle takes place in the virtual Garden of Rebirth, and the patient becomes immersed in the beneficial content of virtual therapy. Therapeutic sessions provided by the VR TierOne medical device have a positive impact on the emotional and behavioural dimension of the patient’s functioning. The lowering of depressive symptoms translates into a better mood and an increase in the sense of one’s own impact on the health situation. The VR therapy initiates and enhances the need to change lifestyle after a cardiac incident, which is crucial for the patient’s future. It is a strong motivation and a sense of self-agency that determine the success of cardiac treatment and rehabilitation. It is also very important to reduce stress by relaxing and developing healthy responses to stress. The patient begins to notice that they are able to take responsibility for their health. It is worth noting that the patient has a real impact on most risk factors of ischemic heart disease (diet, physical activity, stimulants). Only age, gender and genetics are non-modifiable factors here. The emotionally supported patient becomes able to better control the modifiable risk factors of coronary artery disease. Thanks to the intervention with VR TierOne, it becomes possible to restore mental balance and gain commitment to solving a health problem. Mentally empowered patients are able to make an effort to care for their own health. A patient relieved of symptoms of depression, anxiety and stress is more likely to keep their heart in good shape. Making the necessary lifestyle modifications prevents the dangerous combination of depression and heart disease from recurring.