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Stanford Report, August 20, 2003

Depression, heart disease link studied


In an effort to learn more about the well-documented connection between depression and heart disease, medical center researchers are studying whether using psychotherapy to treat depressed patients who have cardiovascular risk factors can decrease their risk of heart disease.

The study, called IMPROVE for IMProve mood/Reduce risk Of Vascular Events trial, will examine the relationship between depression and cardiovascular physiology, risk factors and biological variables. Seventy patients with depression will be randomly assigned to one of two groups. One group will receive cognitive behavior therapy immediately, while the other won’t receive the therapy until several months later.

"Our hope is that we will see some cardiovascular benefit from the therapy," said C. Barr Taylor, MD, professor of psychiatry and behavioral sciences, who is leading the study. "We want to change the patients’ cardiovascular physiology."

According to a study published in the American Journal of Cardiology, 20 percent of patients with coronary heart disease suffer from major depression and 20 percent from minor depression. While evidence shows that depressed people often neglect their health, putting them at increased risk of cardiovascular events, Taylor said biological issues may also contribute. People with depression may have changes in their heart rhythm, which put them at risk for heart attack and a metabolic disorder known as Syndrome X — a cluster of symptoms that can lead to heart attack.

Taylor’s study builds on ENRICHD, a large multicenter study in which Stanford participated that aimed to determine whether treating depression with psychotherapy reduces the risk of cardiac death. The study, which provided treatment to post-heart attack patients, demonstrated a significant reduction in depression but found little effect on mortality rates.

"Unlike ENRICHD, people in this study have not had a heart attack," said Kristine Luce, PhD, a postdoctoral fellow involved with the study. "We’re looking at these issues earlier on in the disease process."

During the study, the 70 depressed participants will go through four months of therapy and be monitored for six additional months. Volunteers will undergo a series of tests, including a psychological stress test.

Participants in the study must be over the age of 55, depressed and at risk of heart disease (high blood pressure and/or high cholesterol). Participants can be taking medications for their depression. Interested volunteers should call 723-2229.

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