As we age and may face more health challenges, depression may work its way in as a comorbidity or “companion,” health challenge to a developing health situation. Such is the case of patients who develop cardiovascular disease and then depression as a result.
Depression is a major health concern in our aging population. It may be a major health concern for you. Look at this revealing study in the medical journal Quality of Life Research (1) – it comes from Columbia University. Here the research team wanted to see what conditions caused the greatest loss in quality of life in patients 65 years and older. The average remaining years of these patients was to age 77 years.
They looked at nine leading conditions: depression, diabetes mellitus, hypertension, heart disease, stroke, emphysema, asthma, arthritis, and cancer to see what robbed aging patients of the most “quality of life” years.
By far – the biggest thief was depression taking nearly 2/3rds of an aging persons quality of life years away from them after age 65. The researchers rightfully concluded that this needs to get fixed.
Even a mild depression robs quality of life
Depression does not have to be severe to be a quality of life “thief.” The same research team in a later 2017 study (2) wrote: (Our) study not only confirmed the significant burden of disease for major depressive disorder among the U.S. elderly, but also showed an incremental decrease in Quality-adjusted life years with an increasing severity of depressive symptoms as well as significant Quality-adjusted life years loss due to mild depression. Specifically, individuals with higher (or more impaired – depression questionnaire scores) scores had significantly fewer Quality-adjusted life years and our findings of fewer years of Quality-adjusted life years for persons with major depressive disorder and mild depression were not only statistically significant but also clinically important.”
A worse quality of life was measured in people with depression and congestive heart failure.
In August 2018, the same researchers lead another study published in the journal Medical Care: (3) This time they wanted to measure the burden of 15 chronic diseases on quality of life in people over 65 years old and what were the effects if the person suffered from more than one of these health challenges. The worse quality of life was measured in people with depression and congestive heart failure.
The link between cardiovascular disease and depression is much more complicated than treating depression and treating heart disease as individual problems
The link between cardiovascular disease and depression is much more complicated than treating depression and treating heart disease. Clinicians must look at the body holistically and investigate common and root causes to both issues. This is the suggestion of a March 2019 study from the Hannover Medical School in Germany (4). Of course at the Magaziner Center for Wellness we have made this connection in the more than 30 years of providing holistic medicine services.
Here is what the researchers suggested:
Major depression is the most common mental disorder and a leading cause of years lived with disability. In addition to the burden attributed to depressive symptoms and reduced daily life functioning, people with major depression are at increased risk of premature mortality, particularly due to cardiovascular diseases.
Several studies point to a bi-directional relation between major depression and cardiovascular diseases, thereby indicating that both diseases may share common physiological pathways.
These include lifestyle factors (e.g. physical activity, smoking behavior), dysfunctions of endocrine systems (e.g. hypothalamus-pituitary adrenal axis), and a dysbalance of pro- and anti-inflammatory factors.
Treating “inflammaging,” and attacking both problems at once.
Inflammation + Aging = Inflammaging
A September 2019 study published in the International Journal of Molecular Sciences, (5) helps us understand the phenomena of “Inflammaging.”
“It has been proposed that a chronic state of inflammation correlated with aging known as inflammaging, is implicated in multiple disease states commonly observed in the elderly population. Inflammaging is associated with over-abundance of reactive oxygen species in the cell, which can lead to oxidation and damage of cellular components, increased inflammation, and activation of cell death pathways.”
Managing and controlling chronic inflammation is a key strategy to our wellness programs here at the Magaziner Center. We examine the role of inflammation as a catalyst in depression and cardiovascular disease in aging patients.
Inflammation is therefore an important biological event that might increase the risk of major depressive episodes
Doctors at the University of Illinois helped bring us a clue that people who are not well physically become depressed because of a phenomena called “sickness behavior.” Sickness behavior is caused by the immune system’s inflammatory response to illness. This study was published in the prestigious Nature reviews. Neuroscience.(6)
Here is a quote from the research, it will explain what sickness behavior is. You may realize as you read this that you already knew what sickness behavior is: “In response to a peripheral infection, innate immune cells produce pro-inflammatory cytokines (immune messengers) that act on the brain to cause sickness behavior. When activation of the peripheral immune system continues unabated, such as during systemic infections, cancer or autoimmune diseases, the ensuing immune signalling to the brain can lead to an exacerbation of sickness and the development of symptoms of depression in vulnerable individuals. These phenomena might account for the increased prevalence of clinical depression in physically ill people. Inflammation is therefore an important biological event that might increase the risk of major depressive episodes, much like the more traditional psychosocial factors.”
This is a study that comes from the National Institutes of Health, September 2018, published in the journal Nature reviews. Cardiology. (7)
Most older individuals develop inflammaging, a condition characterized by elevated levels of blood inflammatory markers that carries high susceptibility to chronic morbidity, disability, frailty, and premature death.
Potential mechanisms of inflammaging include increased susceptibility to disease, central obesity, increased gut permeability, changes to microbiota composition, cellular senescence (your cells stop dividing (you have trouble healing and fighting disease)), oxidative stress caused by dysfunctional mitochondria (energy levels drop and oxidative damage occurs), immune cell dysregulation, and chronic infections.
Inflammaging is a risk factor for cardiovascular diseases, and clinical trials suggest that this association is causal. (Aging can cause inflammation, inflammation can cause ageing, inflammation can cause cardiovascular disease, etc.)
Inflammaging is also a risk factor for chronic kidney disease, diabetes mellitus, cancer, depression, dementia, and sarcopenia (muscle loss).
Researchers concluded inflammaging is associated with the decline of vascular function, which is a critical risk factor for the onset of cardiovascular disease. Furthermore, oxidative stress as a result of the decline of cellular proliferation, senescence, and loss of adaptive immune function, immnunosenescence, is characteristic of age-onset diseases such as cardiovascular disease.”
The researchers also suggest that among other treatments, doctors should explore the nutritional component. They suggest more research into these factors:
Metabolites, phytochemicals and micronutrients can diminish the risks of age-related diseases and inflammaging.
Endothelial progenitor cells (the cells of the blood vessel lining) play a critical role in neo-angiogenesis and vascular aging. It was found that Mediterranean diet nutraceuticals regulate the population and the physiological condition of endothelial progenitor cells, thus mitigating the process of inflammaging in the cardiovascular system.
The consumption of diets including whole grains cereals, vegetables, fish and fruits have been shown to have protective, antioxidant and anti-inflammatory effects.
Sulforaphane, present in cruciferous vegetables such as broccoli sprouts, possesses anticarcinogenic and antioxidant properties.
To treat cardiovascular disease and depression, one should treat inflammation.
A New Path of Treatment
The researchers in this study recognized the co-factors that circle around, through and between cardiovascular disease and depression need to be treated as a whole. To treat depression and cardiovascular disease you need to treat the whole body.
At the Magaziner Center for Wellness we explore the role of inflammation as it connects to many diseases and health issues. We look for links to how depression and cardiovascular disease are linked by inflammation and how treating these problems means treating the whole body and a vast array of possible co-conditions.
If you would like more information, please contact our office so we can start a conversation with you.
1 Jia H, Lubetkin EI. Impact of nine chronic conditions for US adults aged 65 years and older: an application of a hybrid estimator of quality-adjusted life years throughout remainder of lifetime. Qual Life Res. 2016 Jan 18.
2 Jia H, Lubetkin EI. Incremental decreases in quality-adjusted life years (QALY) associated with higher levels of depressive symptoms for U.S. Adults aged 65 years and older. Health Qual Life Outcomes. 2017;15(1):9. Published 2017 Jan 11. doi:10.1186/s12955-016-0582-8
3 Jia H, Lubetkin EI, Barile JP, Horner-Johnson W, DeMichele K, Stark DS, Zack MM, Thompson WW. Quality-adjusted Life Years (QALY) for 15 Chronic Conditions and Combinations of Conditions Among US Adults Aged 65 and Older. Medical care. 2018 Aug 1;56(8):740-6.
4 Kahl KG, Stapel B, Frieling H. Link between depression and cardiovascular diseases due to epigenomics and proteomics: Focus on energy metabolism. Progress in Neuro-Psychopharmacology and Biological Psychiatry. 2018 Sep 6.
5 Zuo L, Prather ER, Stetskiv M, Garrison DE, Meade JR, Peace TI, Zhou T. Inflammaging and Oxidative Stress in Human Diseases: From Molecular Mechanisms to Novel Treatments. Int J Mol Sci. 2019 Sep 10;20(18):4472.
6 Dantzer R, O’Connor JC, Freund GG, Johnson RW, Kelley KW. From inflammation to sickness and depression: when the immune system subjugates the brain. Nat Rev Neurosci. 2008 Jan;9(1):46-56. doi: 10.1038/nrn2297. PMID: 18073775; PMCID: PMC2919277.
7 Ferrucci L, Fabbri E. Inflammageing: Chronic inflammation in ageing, cardiovascular disease, and frailty. Nature Reviews Cardiology. 2018 Jul 31:1.