Mental health, heart health linked: How should treatment approach be impacted?

ByAron Tendler, MD, C.BSM

Fact checked byShenaz Bagha

Key takeaways:

Individuals with cardiovascular issues are at higher risk of developing mental health disorders.
Patients must see the care process as comprehensive, clinicians must delve into patient’s whole history.

Is there such a thing as having a broken heart from depression?

One study suggests the idea may not be far-fetched. Recent research shows that young adults who express feelings of depression are more likely to develop cardiovascular disease and have poor heart health. While the matters of the heart are interesting in themselves, an important answer that providers can seek is what the connection between the heart and mind can tell us about treatment for these conditions.

Infographic of Aron Tendler at left, text at right

Which comes first?

Research demonstrates that individuals with CVD are at a higher risk of experiencing mental health disorders such as depression. At the same time, mental health conditions, such as anxiety and depression, have also been shown to contribute to cardiovascular diseases. As of now, the question of which comes first remains unanswered; however, this is not abnormal in medicine, especially when it comes to mental health. Many known cycles demonstrate the dynamic relationship between physical and mental health.

For example, anxiety can cause poor sleep, while further sleep difficulties can generate greater anxiety.

The connection between heart health and mental health can be impacted by several mechanisms: chronic stress leading to elevated levels of cortisol and adrenaline, which in turn can result in hypertension, inflammation and arterial damage. Another contributing factor of heart damage can be the co-occurring conditions that result from individuals trying to cope with mental health disorders. In extreme cases, this could emerge as alcohol abuse. A more moderate example may look like poor lifestyle habits reflected in poor eating and limited exercise.

While finding the root cause is always the end goal, symptoms and quality of life must be triaged to allow physicians to assess the culprit. To best serve the patient, they must be viewed as a whole, not simply focusing on physical conditions or mental health alone.

Treating the patient as a whole

Patients must view their care as a comprehensive process. When commencing medication for mental health, they should keep close with their providers to determine how it might impact their physical well-being. For example, a study out of the United Kingdom found an association between long-time antidepressant usage and increased risks of coronary heart disease and cardiovascular disease mortality. It is worth noting that despite the associations, it could not be proven that it was the antidepressant and not depression itself that was causing the heart issues, leading experts to warn patients not to stop taking their prescribed drugs.

The idea, however, is that patients should speak with their providers to monitor all vitals and discuss what treatment is best for them.

Overall, the evidence is cited as “conflicting” when it comes to the impact of mental health treatment on outcomes in patients with heart disease. It still warrants discussion and for providers to work with patients and their full care team to discuss all treatment options. One example of this is Deep Transcranial Magnetic Stimulation (Deep TMS), a neurostimulation technology that uses a magnetic coil to activate neural networks in target areas of the brain implicated in mental health and addiction disorders.

Studies have found Deep TMS to be capable of regulating mental and nervous system disorders. It has also been found to be safe with mild adverse events.

In this example, the ability of the treatment to reduce symptoms associated with anxiety and depression could help mitigate the cycle noted above (i.e., anxiety and depression causing strain on the heart). Treatments such as Deep TMS can be used in place of, or in conjunction with, medication to offer providers and patients more options to consider. In turn, they could help address concerns around the impact on the cardiovascular system.

Getting to the heart of patient care

Understanding the complex interplay between the heart and mind can offer significant advancements in both the diagnosis and treatment of a patient. Rather than focusing solely on physical or mental health in isolation, providers must approach patients while looking at the larger picture. This necessitates ongoing and productive dialogue between patients and their full care teams, as well as close collaboration among providers to monitor symptoms and personalize treatments.