Depressed people more likely to die from strokes
People with depression suffer significantly more often a stroke as mentally healthy. One recently published in the scientific journal JAMA study found, Depressive have an increased risk to 45 percent of suffering a stroke. The probability of this widespread disease of dying is even increased by 55 percent. [1] "The results show that depression is an important risk factor for stroke is" the authors write lead investigator An Pan of the Harvard Medical School of Public Health, Boston.
"People with depression in particular need to be informed about the known risk factors for a stroke, such as high blood pressure, poor nutrition or little exercise," advises Prof. Martin Grond from Siegen, board member of the German Neurological Society (DGN) and the German Stroke Association. Society (DSG).
About 16 percent of the population will experience depression in their lifetime.[2] In addition to dramatic consequences for the private and professional lives of those affected, depression has been shown to harbor other health risks. Earlier studies showed that depressed people are more likely to develop diabetes, high blood pressure and cardiovascular diseases.[3,4,5] It was previously unclear that depressed people also have a higher risk of suffering a stroke. With more than 250.000 cases a year, stroke is also one of the widespread diseases in Germany. Therefore, the results of Pan and his colleagues are not only medically but also economically significant for the healthcare system.
Depressed people are more likely to suffer a stroke – more often with the most serious consequences
To get to the bottom of the risk of stroke in depressed patients, the authors conducted a meta-analysis. To do this, they used data from a total of 317.540 people from 28 prospective population studies. At the beginning, doctors examined the subjects for depressive symptoms and then looked after them for up to 29 years. During this period, 8478 study participants suffered a stroke. The data shows that depressed people have a 45 percent higher risk of suffering a stroke. Their risk of dying from a stroke was even 55 percent higher than that of people who were mentally healthy. "According to our figures, about 4 percent of all strokes in the USA can be traced back to depression," the authors explain the relevance of their results. Extrapolated to Germany, this would be 10.000 strokes per year. More detailed investigations revealed that depressed people in particular had an ischemic cerebral infarction – not a cerebral hemorrhage – more frequently.
Hormones and an unhealthy lifestyle could be the causes
According to Pan and his colleagues, there are various mechanisms that could explain this connection: On the one hand, it is already known that depression can affect the human hormone balance and increase inflammation. For example, higher blood levels[6] of inflammatory factors such as CRP, IL-1 and IL-6 are found in depressed people, which have been shown to lead to a higher risk of stroke[7].
People with depression live unhealthily
In addition, depressed people are more likely to neglect their health. Studies have shown that depressed people smoke more, exercise less, and eat less.[8] These factors and the resulting secondary diseases such as diabetes and high blood pressure could be partly responsible for the increased risk of stroke in depressed people.
The researchers also warn that taking antidepressants was also associated with a higher risk of stroke. Whether the medication itself or the associated severity of the depression increases the risk is unclear. That's why Pan calls for further studies: "We need to examine the underlying mechanisms more closely in order to better understand the connection between depression and stroke."
Sources
1. Pan, A et al. Depression and Risk of Stroke Morbidity and Mortality. JAMA. 2011; 306 (11): 1241-1249.
2. Kessler RC et al. National Comorbidity Survey Replication. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA. 2003; 289 (23): 3095-3105.
3. Pan A et al. Bidirectional association between depression and type 2 diabetes mellitus in women. Arch Intern Med. 2010; 170 (21): 1884-1891.
4. Patten SB et al. Major depression as a risk factor for high blood pressure: epidemiologic evidence from a national longitudinal study. Psychosome Med. 2009; 71 (3): 273-279.
5. Musselman DL et al. The relationship of depression to cardiovascular disease: epidemiology, biology, and treatment. ArchGen Psychiatry. 1998; 55(7):580-592.
6. Howren MB et al. Associations of depression with C-reactive protein, IL-1, and IL-6: a meta-analysis. Psychosome Med. 2009;71(2):171-186.
7. Kaptoge S et al. C-reactive protein concentration and risk of coronary heart disease, stroke, and mortality: an individual participant meta-analysis. lancet 2010; 375 (9709): 132-140.
8. Strine TW et al. The association of depression and anxiety with obesity and unhealthy behaviors among community-dwelling US adults. Gene Hosp Psychiatry. 2008; 30(2):127-137.
Source: Berlin [DGN]
