Reviewed by Dr Andre Budihardjo, MM and Physician Chu I Ta
Understanding the Relationship Between Coronary Artery Disease and Depression
Published | 6 min read
Find out why depression can lead to coronary artery disease and learn how to manage this mental condition better to reduce the risk of heart issues.
Depression is a common mental disorder that stresses the body. When our bodies are stressed, they can have an impact on cardiac health and vice versa. Patients with coronary artery disease – blockage of the arteries to the heart – are also more likely to suffer depression.
Up to 15% of patients with cardiovascular diseases and around 20% of patients who have undergone coronary artery bypass graft (CABG) surgery experience major depression.
Interestingly, all patients who underwent CABG surgery had their depression symptoms alleviated after recovering from the surgery. On the flip side, depression increases the likelihood of developing coronary artery disease by 50% to 100% in healthy individuals, while existing coronary artery disease patients are 50% to 150% more likely to develop cardiac morbidity.
How Does Stress Impact Heart Health?
Our bodies naturally respond to acute stress. Hormones such as epinephrine (also known as adrenaline) and cortisol prepare our body to react against predators. Stress is the trigger to this bodily response.
Blood vessels constrict to keep more blood in our body core instead of the limbs, leading to rising blood pressure. This response is also commonly known as the fight-fright-flight response, which is vital for our survival centuries ago. However, this automatic physiological reaction has become a problem in today’s world.
Therapists consider a person who experiences a low mood for two weeks or longer to be suffering from clinical depression. Prolonged stress caused by depression does much more harm than good. Long periods of elevated blood pressure mean that the heart delivers blood with more effort. Subsequently, the artery walls harden in response to elevated blood pressure. These physiological changes contribute to the predisposition of coronary artery disease.
Depression can be treated, but only with the right professional intervention. If you notice someone showing signs of depression, advise them to seek proper medical attention.
How Depression is Linked to Coronary Artery Disease
In Traditional Chinese Medicine (TCM), physicians historically regard mental disorders as diseases of the heart (心病, xin bing). It turns out that TCM physicians were right about treating heart diseases and mental disorders together. We have a higher chance of success when we treat the medical condition from a broader perspective.
Coronary artery disease is a narrowing or blockage of your coronary arteries. It is usually caused by the buildup of fatty material called plaque. According to Chu I Ta, Chief TCM Physician of Real Health Medical, TCM regards the plague as a metabolic waste product. This element is not useful in the body and needs to be excreted out from the body.
“This metabolic waste product is also considered as phlegm (痰)and blood stasis (血瘀), which are the pathological factors of illness. Thus, many diagnosed patients may suffer from coagulation or stagnation of the phlegm and stasis to a certain extent,” he explains.
The holistic approach of TCM theory regards the development of coronary artery disease to be closely related to not only the heart but other organs as well. “The 5 organ systems develop five different qi (vital life energy), thus creating different emotions including joy (heart), anger (liver), worry (spleen), grief (lungs), and fear (kidney),” physician Chu elaborates. The symposium “Nourishment and Life Extension” states that “overwhelming and unstable emotions can be harmful to the body”.
“From this point of view, excessive emotional change like sadness or depression can affect the heart organ and transpire into coronary artery disease,” he notes.
Keeping Your Heart Healthy to Prevent Coronary Artery Disease
The risk factors associated with coronary artery disease include:
- familial inheritance
- cholesterol issues
While plaque buildup in coronary artery disease begins as early as childhood, we can still reduce the risk factors by leading a healthy lifestyle and complementing a healthy diet with TCM herbal remedies.
Diet and Lifestyle
Both Western medicine and TCM agree that a well-balanced lifestyle and diet is the key to a healthy heart. Physician Sam Ng from Eu Yan Sang TCM clinic suggests having meals with less oil, salt and sugar and avoiding cold, deep-fried and barbecued food. The ideal diet is low-fat and high in fibre. You should also exercise regularly, have adequate time for rest, manage your emotions, quit smoking, and refrain from alcohol overconsumption.
TCM Herbal Remedies
TCM believes in treating diseases holistically by viewing symptoms not arising from a single primary organ but as a relationship of the primary organ with other organ systems. Hence, taking good care of cardiac health benefits mental well-being and other aspects of health. Patients with existing coronary artery disease must take the necessary steps to prevent depression from developing.
A 2019 research stated that patients with depression are at high risk of developing hypertension, a major risk factor for developing coronary artery disease. Therefore, it is important to take depression into consideration during the process of prevention and treatment of hypertension. The research further highlighted that Xiao Yao San (XYS), originated in the Formulae of the Bureau of People’s Welfare Pharmacies (Taiping Huimin Hejiju Fang in Chinese) in the Song Dynasty of China (960–1127 CE), is one of the most utilised TCM classic herbal formulae for treating both depression and hypertension.
The XYS decoction comprises eight crude herbs, which help relieve the three basic pathogenesis of hypertension: liver qi stagnancy, spleen qi deficiency, and fluid retention:
- Thorowax root (chaihu, radix bupleuri)
- Chinese angelica root (danggui, radix angelicae sinensis)
- White peony root (baishao, radix albus paeoniae lactiﬂorae)
- White atractylodes rhizome (baizhu, rhizoma atractylodis macrocephalae)
- Poria (fuling, scierotium poriae cocos)
- Liquorice root (gancao, radix glycyrrhizae)
- Field mint (bohe, herba menthae haplocalycis)
- Fresh ginger rhizome (shengjiang, fresh rhizoma zingiberis)
You can also complement your daily meals with natural and healthy ingredients. For instance, longan may reduce stiffening of the arteries, which is a symptom of coronary artery disease. Add pieces of dried longan to your drink to enjoy the benefits of this heart-healthy fruit. Goji berries are also a delicious addition. These tiny little fruits contain multiple vitamins and antioxidants to help improve blood circulation and sleep.
A happy heart means a happier, healthier person. By maintaining a nutritious diet and a well-balanced lifestyle, you can reduce the risk of developing coronary artery disease.
- European Heart Journal. 2020. Depression and coronary heart disease: 2018 position paper of the ESC working group on coronary pathophysiology and microcirculation. [Accessed 26 November 2021]
- Cleveland Clinic. 2019. Depression & heart disease. [Accessed 26 November 2021].
- National Library of Medicine. 2013. Depressive symptoms after CABG surgery: a meta-analysis. [Accessed 26 November 2021].
- Phytomedicine: International Journal of Phytotherapy and Phytopharmacology. 2019. Efficacy and safety of Chinese herbal medicine Xiao Yao San in hypertension: A systematic review and meta-analysis. [Accessed 26 November 2021].
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