Mental health and heart health are surprisingly connected

Mental health and heart health are surprisingly connected

Çoloquially, our minds and hearts are positioned as total opposites. Being logical is known as “using your head”, while making a decision based on emotions is “following your heart”. But according to science, the head and heart may not be operating so independently after all. In fact, decades of research have revealed a strong connection between mental health and heart health, so a substantial drop in either could also be linked to a decline in the other.

Perhaps the clearest link between mental health and heart health comes when you look at related research on depression. Since depression is one of the most common mental health conditions, affecting an estimated 21 million Americans each year, it’s a useful proxy for thinking about how mental health issues might interact with general heart health conditions.

The prevalence of depression in people with heart disease is twice that of the general US population.

“For people who have depression, we know that the likelihood of developing heart disease is significantly higher than people who don’t have depression,” says cardiac psychiatrist Christopher Celano, MD, director of the Cardiac Psychiatry Research Program at the General Hospital of Massachusetts. “Research also shows that people who already have heart disease are also at greater risk of developing depression than those who don’t,” he says. In fact, the prevalence of depression in people with heart disease is twice as high as in the general US population (between 20 and 30 percent, compared to 7 to 8 percent). For people who fall into this camp, the results are also often worse. A January 2022 study found that having a psychiatric condition alongside a chronic illness like heart disease doubles your risk of death.

As a result, experts in cardiac psychiatry — who focus on treating mental health issues in people with existing heart conditions — suspect that the head-heart connection is bidirectional, with mental health issues potentially worsening heart health and health conditions. of the heart increasing your chances of mental illness. health problems. While much of the research in this area focuses on depression, there’s also evidence that anxiety disorders, post-traumatic stress disorder, and even chronic stress won’t do your heart any favors either. And doctors suspect that a few key factors are likely driving the association between mental health and heart health in general.

How having mental health problems can increase your risk of heart disease and vice versa

behavioral paths

Many studies have shown that making lifestyle choices that are generally health-promoting — say, eating a nutrient-dense diet and exercising regularly — can substantially lower your chances of getting heart disease. Because having a mental health condition can make you any less likely to do all of the above, this is one of the main ways to put you at greater risk.

“We know that people who are depressed or anxious may not do as good a job of taking care of themselves,” says cardiac psychiatrist Peter A. Shapiro, MD, professor of psychiatry at Columbia University’s Irving Medical Center — likely because of the way how these diseases affect a person’s energy and executive functioning (also known as their ability to plan and complete goals and tasks). “If, for example, they’re not paying close attention to what they’re eating, getting enough rest, taking their medication or exercising regularly, they may be more likely to develop heart problems in the future.”

The same thing applies when it comes to the opposite type of habits with known cardiovascular health risks, says Dr. Celano. Data shows that people with mental health disorders are more likely to smoke and drink – two practices with negative impacts on the heart – which may also help explain the connection between depression and poor heart health.

It is also likely that certain behavioral tendencies common to people with heart disease may increase their risk of developing a mental health condition. “You can imagine that someone with heart disease might be less able to engage in physical activity,” says Dr. Celano. As physical activity itself is known to have some antidepressant effects, a person in this situation would be missing out on these benefits.

That effect would only be compounded by any of the negative psychological impacts of getting diagnosed with heart disease in the first place, says Dr. Shapiro. “For some people, the stress of having their normal life role or process disrupted by heart disease can be enough to cause depressive symptoms,” he says. Not to mention the potential pain and fear involved with having a cardiac event or spending time in the hospital, both of which can also increase a person’s risk of mental illness.

Physiological pathways

The science on the physiological links between mental health and heart health is a little more limited, says Dr. Celano. “Most biological connections tend to be proven at one point in time, so it’s harder to figure out which direction the relationship is really going.” (In other words, it is unclear whether one causes the other, or whether any observed biological abnormality is simply the result of having both.)

That said, certain physiological pathways are likely involved in one way or another. For starters, people with depression have been shown to have higher levels of interleukins (proteins produced by white blood cells) in their blood, suggesting higher levels of inflammation that could put them at greater risk for heart disease, says Dr. Celano. The reverse may also be true, as people with severe heart disease also tend to have elevated levels of inflammation, which may contribute to or worsen depressive symptoms, he adds.

People with depression, in particular, are also more likely to suffer from endothelial dysfunction, “which means the lining of your blood vessels isn’t as good as it should relax to allow blood flow to your heart,” says Dr. Celano. Without healthy blood flow, the heart cannot do its job as effectively.

Add in the potential cascade of neuroendocrine effects common to psychiatric conditions and you have yet another interesting link between mental and heart health. “In general, people who are depressed or anxious, for example, tend to experience more sympathetic nervous system activity. [aka fight-or-flight] than parasympathetic [aka rest and digest]”, says Dr. Celano. Translation? These people are likely to experience more frequent spikes in blood pressure and heart rate, and higher levels of cortisol coursing through their bodies than non-depressed people, which can put a lot of extra stress on the heart over time.

Why maintaining good mental health and a positive outlook can help protect your heart

Based on recent research linking optimism to heart health, there is also something to be said for the unique benefits of a heart-positive psyche. “We are seeing that it is not just the lack of depression that tends to have protective cardiac benefits,” says Dr. Celano. “There appears to be a beneficial effect of positive emotions that is distinct from the negative impact on the heart of feeling depressed.”

Part of this connection is rooted in the opposite behavioral effect, as noted above: research shows you are most likely to engage in heart-healthy behaviors if you’re optimistic. “Specifically, optimistic people are more likely to eat more fruits and vegetables, be more physically active, and take their medications,” says Dr. Celano – all of these are ideal for keeping a heart working well.

There is also likely to be a supportive neuroendocrine link between having a positive outlook and maintaining a healthy ticker. In fact, research on positive affect has shown that it can lead to more parasympathetic activity (rest and digestion) and lower cortisol levels, reducing the frequency of blood pressure and heart rate spikes as a result.

All of which is to say that there is a significant and measurable benefit to heart health in experiencing a positive state of mind – which is why Dr. Celano emphasizes the importance of seeking treatment for any mental health condition and of finding ways to support your psyche on a daily basis, regardless. “Even if you don’t have depression, anxiety, or any other mental illness, taking care of yourself, cultivating gratitude, and doing things that feel important and meaningful can actually have benefits not only for your emotional well-being, but your health as well. heart”, he says.