Coronary atherosclerotic heart disease (CHD) is one of the diseases that seriously threaten the life expectancy and quality of life of the general public. In recent years, the age of onset of CHD has gradually become younger due to the improvement of living standards and the proliferation of poor lifestyles. However, while we are constantly looking for treatment and prevention of coronary heart disease, has it ever occurred to us that coronary heart disease may be related to our long-term bad moods?
Thirteen prospective studies of more than 4,000 healthy individuals followed for an average of 10 years showed that depression is an independent risk factor associated with cardiovascular disease prevalence and mortality, with patients with major depression having more than four times the risk of coronary heart disease than individuals without depression, and those with depressive symptoms that do not meet the diagnostic criteria for depression, known as “subsyndromal depression,” having more than four times the risk of coronary heart disease. The risk of coronary heart disease is also 1.5C2 times higher in patients who have depressive symptoms but do not meet the diagnostic criteria for depression, so-called “subsyndromal depression” than in those who are not depressed. As an independent risk factor in the development of cardiovascular disease, depression is comparable to risk factors such as hyperlipidemia, hypertension, and diabetes mellitus.
On the other hand, epidemiological studies have shown that the prevalence of depression among patients with coronary heart disease is about 20%. Post-infarction major depression is about 15-30%, with 65% exhibiting at least mild depression. More than 30% of patients have depressive symptoms before coronary artery bypass grafting. Numerous studies have confirmed that depression can increase the incidence of cardiovascular events in coronary patients and that depression can also increase mortality due to cardiovascular events.
Foreign studies have shown that 16.5% of patients with depression died six months after an infarction, compared to 3% of patients without depression; at 1.5 years after an infarction, the mortality rates were 20% and 6% for the two groups, respectively. In other words, depression increased the risk of death in patients with heart attack by more than three times. Therefore, depression has a very negative impact on coronary heart disease, both before and after the disease. However, in contrast to the high prevalence of depression in combination with coronary heart disease, only 10% of depressed patients after infarction are identified, let alone treated.
Possible reasons for the low recognition rate are.
1. atypical presentation of depression: e.g. hostility, restlessness and withdrawal are more common than sadness.
2. depression is often perceived as a normal reaction to a serious medical event, such as a heart attack – it is considered natural to be in a bad mood after such a serious illness
3. most uncomplicated heart attack patients have a short hospital stay, making it difficult for physicians to evaluate the patient’s mood in the limited time available and more difficult for the patient to obtain a consultation with a psychiatrist/psychologist.
From this example we see several characteristics.
1. The patient has obvious self-conscious symptoms, but little evidence of objective examination.
2. Emotional symptoms are prominent and interpersonal relationships are altered.
3. Prominent fatigue, laziness, and failure to perform even minimal grooming activities.
4.Interest decreases, and things that I liked before (watching Korean dramas) are no longer enjoyed.
5. Feeling useless, not having the face to see others, not willing to talk to the neighbors. I even feel that I have dragged my family down and have thoughts of lightness of life.
6.The medication like nitroglycerin seemed to be effective when she had chest pain, but it gradually became ineffective. A coronary angiogram again showed that her coronary arteries were patent. The cause of the chest pain was obviously not due to myocardial ischemia.
7. Antidepressants are effective.
The following are the clinical manifestations of depression in patients with three main groups of symptoms.
1. Core symptoms.
Depressed mood all day long, wanting to cry, diminished interest, hedonistic inability to be happy knowingly, but not interested and happy, lack of energy and excessive fatigue feeling like they are always doing heavy work and physically exhausted with no strength at all.
2. Psychological symptoms.
Expression of anxiety fidgeting, excessive worry about themselves or their families; self-blame and blame themselves for causing trouble to their families; cognitive distortion and self-depreciation, thinking that they are useless, anyone is better than themselves, they can’t do anything well; everything is thought of in a bad way, can’t see the positive side of things; suicidal ideas and behaviors feel that life is meaningless, it is better to die, and even put into action.
Incomplete self-knowledge does not think he has depressive symptoms, thinks he is a physical disease, does not accept the fact that all objective examinations are normal, thinks the doctor did not check, repeatedly asks for examination. Decreased cognitive function poor concentration, memory loss, reduced efficiency in doing things, inability to perform daily tasks as skillfully as before. Patients with severe psychotic symptoms will have psychotic symptoms such as hallucinations, hallucinations, or relationship delusions, but most of them are related to the reality of the patient’s life without absurd and bizarre hallucinations.
3. Somatic concomitant symptoms.
They are manifested as various, bizarre somatic discomfort. Such as various kinds of pain, headache, back pain, etc., the pain is not fixed, wandering or series of pain, one after another; sleep disorders, insomnia or too much sleep without relief, appetite disorders, reduced eating or gluttony, loss of libido, non-specific somatic symptoms, patients can show a variety of bizarre symptoms, such as feeling half of their brain become empty, feel a gas from the lower body all the way up to the throat choking, etc..
The first group of core symptoms is the most dominant among the three groups of symptoms. If 1 or 2 symptoms persist for more than 2 weeks, you should promptly seek a psychiatrist for identification and judgment to avoid delaying the condition. It is important to remember that depression can exist alone or secondary to somatic diseases, such as coronary heart disease, stroke, thyroid disease, Alzheimer’s disease, etc. Particular attention should be paid to exclude somatic diseases in the first onset of depression in the elderly.
First of all, Chinese people who grew up in the Eastern culture have an innate sense of shame about depression and think that having depression (or mental illness) is a matter of shame and a problem in their minds. They do not want to admit that they have this disease. Or they think that saying they are in a bad mood means that their children are not filial.
Second, although admitting that they are in a bad mood, they think that they can overcome it by their own adjustment.
Thirdly, they are afraid to take them because they are worried about the side effects of drugs.
Fourth, they think that antidepressants add to the already heavy financial burden.
In fact, depression, like other physical illnesses, is a more common disease than the flu, with a prevalence of 6% in the general population and an even higher prevalence in the elderly, with the prevalence of depression in elderly inpatients as high as 36%.
Why are elderly people prone to depression when they have a physical illness?
Physiologically speaking, the physiological functions of all organs of the elderly are not as good as before, the most common ones are cataracts that make vision diminish, neurological deafness that makes hearing decline, and degeneration of joints that makes movement slow.
As we all know, “medicine is toxic in three parts”. Therefore, it is reasonable to be concerned about adverse drug reactions. The first thing people do when they get a drug prescribed by a doctor is to read the instructions carefully, and this sense of self-protection is right, but the key is that depressed patients have a distorted perception and tend to over-exaggerate the side effects of drugs instead of paying attention to the therapeutic effects of drugs, especially when they see that there are symptoms of their current existence in the adverse reactions, they resist even more, “I was already dizzy, you I’m already dizzy, and the medicine you gave me will cause dizziness, so I can’t take this medicine!”
Instead of paying attention to the fact that the least that can happen when a drug is approved for marketing to patients is that the incidence of adverse reactions should be very low, perhaps one in a thousand or one in ten thousand, and not all people who take the drug will experience them. It is also forgotten that if depression is not treated, the incidence of coronary angina or heart attack will increase many times and will lead to serious consequences.