Severe depression: do’s and don’ts.

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Adapted by Brian Hennessy from article in Psychology Today.



The Do's

Do recognize that depression by itself appears to be a risk factor for heart disease—one that may be modifiable, by aggressive treatment of the mood disorder.

Do take extra steps to separately minimize the risks of heart disease. Be sure to eat a diet low in saturated fats and rich in fruits and veggies.

Do get as much exercise as possible. Exercise combats both depression and heart disease directly. It creates changes in brain cells. It improves blood lipid levels and counters the tendency to obesity that may lead to heart disease. Do pay special attention to diet and curb the intake of saturated fats. It's necessary to preserve blood flow to your heart and to your brain. Plus it influences the composition of nerve cell membranes.

Do increase consumption of omega-3 fats. They seem to have specific effects on many of the mechanisms of heart disease implicated in depressed persons.

Do cut down on consumption of omega-6 fats, commonly found in fried and processed foods, which rely on soy and corn oils. Do consider taking omega-3 supplements. The American Heart Association recommends 1 gram of omega-3s for those who have heart disease.

Do develop a variety of ways of tackling stress even during remission. Stress can be stopped on the way in by meditation, its impact blunted via exercise. It's when stress overwhelms coping resources that depression results. Do encourage anyone close to you who suffers a heart attack to undergo a formal psychiatric evaluation. Identification and treatment of depression are the new standard of care for heart attack patients.

Do know that while older antidepressants are cardiotoxic, the newer antidepressants, notably the SSRIs, have been proved safe for treatment of depression in the presence of heart disease. 


The Don'ts

Don't delay treatment for depression, as it appears to be a strong independent risk factor for heart disease and cardiac death. The longer depression exists, the harder it is to cure and the more entrenched the risk.

Don't settle for less than aggressive treatment of depressive symptoms. The goal is complete return of well-being. It may take total elimination of depressive symptoms to reduce the risk of relapse or of heart disease.

Don't just treat depression. Evidence so far suggests that you also need to also specifically combat the risk of heart disease on several fronts.

Don't just curb your intake of saturated fats. Be sure to use monounsaturated fats such as olive oil and to consume liberal amounts of omega-3 type of polyunsaturated fats, found most abundantly in ocean fish. The American Heart Association recommends 2-3 servings a fish a week to prevent heart disease, 1 gram a day for cardiac patients.

Don't let the inertia and withdrawal produced by the condition stop you from helping someone who is depressed. The best thing you can do is take them out for walks regularly—30 minutes at least three times a week. Exercise directly and indirectly counters the known risk factors for heart disease in depressed people.

Don't neglect signs of depression after a cardiac event. Depression is common after a heart attack, and is the single biggest predictor of survival. Do seek treatment of the depression as well as other specific cardiac risk factors. Take care folks. Brian.


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