Depression Hastens Early Death (November 29, 2007) By Matt Brignall, ND

Does Depression Kill? This question was asked this week in an editorial in the Archives of Internal Medicine.1 The author concluded that depression does appear to increase death rates independent of other known risk factors.

This conclusion was based in part on two articles, also appearing in this week?s issue. The first studied the relationship between depression and risk of death over a six-year period in people over 65 years of age.2 Depression was found to predict the death rate independent of the presence of disease or risk factors for disease, physical exam findings, and socioeconomic status. People with depression were 35% more likely to die over the six-year study.

These results support some,3 4 but not all,5 6 previously published studies. This study is the first to control for socioeconomic and medical risk factors, making it the most rigorous investigation of the effects of depression on death rates yet published. A major shortcoming of this study is the lack of data regarding causes of death. Previous studies have found that a history of depression increases the risk of death from heart disease,7 an issue that was discussed in the May 25th edition of Newswire.

On a ten-item depression survey, agreement with either of the two following statements was independently associated with the future risk of dying: ?I felt everything I did was an effort? and ?I could not get going.

Authors of the second study also published in the current Archives of Internal Medicine found that patients with either mild-to-moderate or major depression were significantly less likely to follow their doctor?s recommendations after suffering a heart attack.8 This was true for both diet and lifestyle recommendations and compliance in taking prescribed medications.

The first study shows that depressed people who lack motivation are more likely to die than those who are not depressed. The second study concludes that those who are depressed are less likely to comply with their doctor's recommendations than is the general population. In other words, a patient who would agree with the statement ?I felt like everything I did was an effort? on a questionnaire may be less likely to eat a healthful diet, exercise, or take medication and may therefore be more likely to die earlier.

However, the association between depression and increased death rates may extend beyond a lack of compliance with medical advice. Depression may take its toll on the body in ways as yet undiscovered. Further studies are needed to fully understand why depressed people seem to die at a younger age than do people who are not depressed. Even before these issues are resolved, depressed people need treatment??not simply to feel better psychologically, but to stay alive and healthy as well.

The findings of these new studies support the conclusion of the accompanying editorial: Depression now demands the aggressive level of research in the next quarter of a century that smoking, cancer, and heart disease have received in the past quarter of a century.

Source:

1. Wulsin LR. Does depression kill? Arch Intern Med 2000;160:1731?2.
2. Schulz R, Beach SR, Ives DG, et al. Association between depression and mortality in older adults. The Cardiovascular Health Study. Arch Intern Med 2000;160:161?8.
3. Barefoot JC, Schroll M. Symptoms of depression, acute myocardial infarction, and total mortality in a community sample. Circulation 1996;93:1976?80.
4. Rovner BW, German PS, Brant LJ, et al. Depression and mortality in nursing homes. JAMA 1991;265:993?6.
5. Fredman L, Schoenbach VJ, Kaplan BH, et al. The association between depressive symptoms and mortality among older participants in the Epidemiologic Catchment Area?Piedmont Health Survey. J Gerontol 1989;44:S149?S156.
6. Thomas C, Kelman HR, Kennedy GJ, et al. Depressive symptoms and mortality in elderly persons. J Gerontol 1992;47:S80?S87.
7. Ferketich AK, Schwartzbaum JA, Frid DJ, Moeschberger ML. Depression as an antecedent to heart disease among women and men in the NHANES I study. National Health and Nutrition Examination Survey. Arch Intern Med 2000;160:1261?8.
8. Ziegelstein RC, Fauerbach JA, Stevens SS, et al. Patients with depression are less likely to follow recommendations to reduce cardiac risk during recovery from a myocardial infarction. Arch Intern Med 2000;160:1818?23.

Matt Brignall, ND, is a research associate at the Tahoma Clinic in Kent, Washington, and a contributor to the Healthnotes Review of Complementary and Integrative Medicine and Healthnotes Online.