Doctors have known for some time that depression contributes to heart disease.
Now it seems heart surgery can contribute to depression as well.
Just weeks after publisher Philip Merrill apparently took his own life aboard his sailboat on the Chesapeake, the Journal of the American Medical Association published research linking cardiac surgery to depression.
Merrill?s family has said his spirit had “dimmed” following his own heart surgery last year, and the Maryland Medical Examiner?s Office last week ruled his death a suicide.
The article by Dr. Mary A. Whooley said 1 in 5 people with coronary heart disease has a major depressive disorder, as does 1 in 3 patients with congestive heart failure. Whooley practices at the Veterans Affairs Medical Center and the University of California, San Francisco Medical Center.
“It is not known whether treating depression improves cardiovascular outcomes, but antidepressant treatment … is generally safe, alleviates depression and improves quality of life,” Whooley wrote in the article.
Dr. Michael Fiocco, chief of cardiac surgery for Baltimore?s Union Memorial Hospital, said roughly half of all cardiac patients develop depression following surgery.
Though they don?t have strong evidence about what causes depression, it is avoidable in some cases, he said.
“We are actually seeing less of it here than we have in the past,” Fiocco said. “We do a lot of our surgery with the heart still beating.”
Putting a patient on a heart and lung machine seems to contribute to complications like depression, he said, though doctors don?t know exactly why.
Perhaps the steady blood pressure generated by the machine lacks the necessary throb and rhythm of a real pulse, Fiocco said. Keeping the heart beating is not an option for more complicated surgery, like replacing a valve within the heart.
Sometimes the blood pressure medications prescribed after surgery can lower patient?s energy levels as well, he said.
Doctors need to follow up with patients to help them through depression if it crops up, Fiocco said. “You have to be looking for it. You can?t just pat them on the head and say, ?See you in three months.? You have to follow up, let them know they are going to be OK,” he said.
Still, seriously catastrophic depression or even clinical depression requiring medication is rare, Fiocco said, and he?s never seen anyone commit suicide as a result.
Depression is a treatable disease no one should suffer from, said Dr. Bruce Taylor, a depression specialist with Sheppard Pratt Hospital.
“I?ve been doing this full time, and I?ve yet to see someone we couldn?t help,” he said.
