A recent (1/14/97)  New York Times article discusses theories 
about the connection between heart attacks and depression.   

      Noting the strong relationship between depression and heart 
disease, the National Heart, Lung, and Blood Institute is now 
beginning a national study of 3,000 heart attack patients at 8 
centers across the U.S. to see if intervention and therapy for 
depression will reduce the risk of death and heart attack.

      According to the article, Dr. William Eaton of Johns Hopkins
has found in his study that depression is as serious a risk for 
heart disease as high cholesterol.   Dr. Eaton studied 1,551 people 
in the Baltimore area who did not have any heart disease in 1981 
and found that those who were depressed were 4 times as likely to 
have a heart attack over the following 14 years as those who were 
not depressed. 

      According to the article, Dr. Nancy Frassure-Smith of the 
Montreal Heart Institute found in her study that depression was 
as "good a predictor of imminent death from heart disease, 
primarily arrhythmias, as previous history of heart attacks or 
poor functioning of the heart."   Dr. Frassure-Smith studied 222 
patients who had suffered a heart attack and found that those who
were depressed were 4 times as likely to die in the following 6 
months as those who were not depressed.  

      According to the article, Dr. Robert Carney of Washington 
Univ. in St. Louis found that patients newly diagnosed with heart 
disease who were also depressed were twice as likely to have a 
heart attack or require a heart bypass in the following year as 
those patients who had similar blockages but were not depressed. 

      Dr. Carney is quoted as saying that the rate of depression 
among patients with heart disease is close to 18%. According to 
the article, the rate of depression at any given time among the 
general population is only estimated to be about 1.5% - 3%.  

      There is increasing thought that the increased levels of 
cortisol that are commonly found in depressed people may be a 
major cause of heart attack and death.   Cortisol decreases 
secretion of growth hormone, leading to lower levels of HDL 
cholesterol and higher levels of LDL cholesterol, can make heart 
arrhythmias worse, and promotes abdominal obesity, a previously 
recognized risk factor for heart disease.  It is thought that the 
cortisol and  higher levels of epinephrine are a response to the 
type of stress that many depressed individuals experience. 

        As Dr. Philip Gold, Chief of the Neuroendocrine branch
of the Nat'l Institute of Mental Health is quoted as explaining,  
in depression, though the person may feel sad and lethargic,"... 
Your biochemical programs that focus attention only on the danger
stimulus are activated.  Virtually everything else is ignored.  
You won't stop to eat or sleep, you won't participate in sexual 
behavior. Your metabolic responses are altered so that mobilization 
of fuels for fight or flight takes precedence over tissue repair."    
He goes on to say, "the fight or flight response is supposed to 
last for hours, or maybe days," but in depression, "the response 
turns back on itself and doesn't turn off for weeks, months, years."

       Dr. Gold also notes, though, that "every drug that combats 
depression also controls the excessive cortisol secretion that may 
be leading to heart disease."   This is another reason why treating 
depression is important! 

       People who have diabetes have a higher than usual rate of 
depression.  If you think there's any chance that you might be 
depressed, go for a check.  Unfortunately, many doctors don't catch 
depression in their patients and sometimes mistake it for anxiety, 
and then prescribe sedatives that will only make depression worse,  
so if your medical doctor does not notice or think you're depressed, 
that doesn't mean you aren't.  Go see a clinical psychologist or 
psychiatrist and get checked.   If you do have a depression, no 
amount of "stiff upper-lip" will fix it -- you need and  deserve  
true professional help with it. 

      If someone you care about seems depressed but is refusing to 
consider getting help, you might try pointing out to them that there 
may be some serious and terrible medical side effects from letting a 
depression go untreated.   It could be as serious as a heart attack.