Psychiatry

Depression can stop a beating hear

Heart and mind are closely tied.  In fact, 10 to 15 per cent of patients with heart problems also suffer from major depression, and 30 per cent have symptoms of depression.  Specialists agree: treating depression among cardiac patients saves lives.

Should psychological suffering be alleviated through medication or psychotherapy? This is the question that a team of 10 researchers working under psychiatrist François Lespérance, a professor at the Université de Montréal and a physician at CHUM, is attempting to answer. “For people with depressive tendencies, the diagnosis of heart disease is often the last straw,” explains Prof. Lespérance.  “To treat or prevent depression, the common reaction is for the treating physician to prescribe an anti-depressant.  But we don’t think that the pharmaceutical solution is always the best one.”

The research, which was launched in Montreal but includes patients from Toronto, Kingston, Ottawa and Halifax, is intended to evaluate the effectiveness of an anti-depressant (citalopram) and that of interpersonal psychotherapy compared to a control condition, over 12 weeks.  The anti-depressant citalopram will be compared with the placebo and the interpersonal psychotherapy with doctor’s appointments. “It does not involve the kind of psychotherapy that dwells on the relational aspects of the patients suffering from depression. It’s an approach that encourages them to break their emotional isolation.”

Dr. Lespérance has been studying the clinical effects of depression for a long time.  In 1993, he worked closely on a research project cited in the renowned Journal of the American Medical Association (JAMA) that found that depression has an adverse effect on cardiac prognosis. In fact, the oft-cited article revealed that post-heart attack patients suffering from depression were three to four times more at risk of dying within six months following the attack than individuals in good health.

While Dr. Lespérance does not hesitate to approve alternative approaches, he is not opposed to modern medicine. “Anti-depressants have really helped to advance psychiatry and their action continues to be improved. But we must not abandon other therapeutic methods. Let’s not forget that 40 to 50 per cent of patients do not respond well to anti-depressants, that is, 4 to 5 people out of 10. That’s huge. We have to help these people too.”

Depression is a disease that causes a variety of physical and psychological symptoms and it is often linked to interpersonal factors, explains Dr. Lespérance. “It would be fantastic if we had a pill that could transform our behaviour, a pill that could give us the benefits of 20 minutes of exercise,” he jokes. “But since this can’t be done, we have to look for processes that can change behaviour over the long term.” Not surprisingly, this type of research is not of great interest to pharmaceutical companies.  This study would not have been possible without the $1.3 million in funding provided by the Canadian Institutes of Health Research.  And if the 280 patients chosen for the study protocol form a statistically significant cohort, the researcher is excited about the possibility of repeating the study across North America using thousands of subjects.