The American Heart Association has released a statement (circ.ahajournals.org/content/early/2015/08/10/CIR.0000000000000229.abstract) identifying major depressive disorder and bipolar disorder in adolescents as specific risk factors for the early development of cardiovascular disease. Their review of numerous studies shows consistently higher risks of cardiovascular disease in adolescents with mood disorders compared to those without.
Dr. Candida Fink, MD is a board certified child and adolescent psychiatrist who specializes in several areas including mood and anxiety disorders and dual diagnoses of developmental disabilities and mental illness. She treats children, teens, and young adults with a range of concerns including ADHD, anxiety disorders, OCD, autism, pediatric mood disorders, and mental health issues in school settings. Dr. Fink has co-authored two books – The Ups and Downs of Raising a Bipolar Child (with Judith Lederman, Simon and Schuster, 2003) and Bipolar Disorder for Dummies (with Joe Kraynak, John Wiley & Sons, 2005, third edition 2015). She has been featured nationally and locally in broadcast, print, and online media coverage and is a frequent speaker on mental health topics for community and school-based audiences.
Editor: Saad Shaheed
Increased rates of heart disease in adults with depression and bipolar disorder have been well documented, but this is the first full examination of the data in young people with mood disorders.
In looking at the research, the authors discovered a direct relationship between cardiovascular disease and major depressive disorder and bipolar disorder as exhibited by the following conditions:
- Inflammation and oxidative stress — processes that injure cells and disrupt their function
- Shared genetic risk factors for cardiovascular disease and depression
- Sleep disorders, which are known to occur with increased frequency in both cardiovascular disease and mood disorders
Indirect connections also link cardiovascular disease to major depressive disorder and bipolar disorder, including shared environmental and behavioral risk factors such as:
- Increased likelihood of childhood maltreatment in people with mood disorders
- Higher rates of smoking
- Decreased levels of activity
Psychiatric medications — the antipsychotics in particular — may play a role, but antidepressants did not, and the antipsychotics were not the main reason for the increased risk of cardiovascular disease.
Sharing a Common Underlying Biological Risk
The author’s main point is that depression and bipolar disorder are related to cardiovascular disease at a basic biological level. The goal of their statement is to highlight this connection, so that physicians include this information when developing treatment plans for both types of illness.
The take home messages are that the treatment of young people with mood disorders must include cardiovascular disease awareness and risk-reduction strategies. Simultaneously, recognition and treatment of mood disorders in youth is an important part of reducing risk of early cardiovascular disease.
Reducing the Stigma of Mental Illness
The formal statement by the American Heart Association speaks loudly, above and beyond treatment guidelines. These cardiologists state unequivocally that bipolar disorder and depression are medical illnesses and that good health care is integrated care.
This type of publication, from outside of psychiatry, is of enormous value on the road to reducing stigma around psychiatric illness. When the broader medical community breaks down the false wall between physical and mental health care patients, families and the broader community will follow. And all health care will benefit from a more compassionate, scientifically supported approach that does not diminish and segregate psychiatry, but rather includes it as part of all high-quality health care.