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Mental Health

Depressed And Bipolar Teens May Be At Higher Risk For Heart Disease

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Last week , the American Heart Association released a statement calling on doctors to consider mood disorders when assessing teens for cardiovascular risk.  The authors reviewed recent research showing a link between mood disorders and cardiovascular disease. They concluded when screening for cardiovascular disease in teens, doctors should look beyond traditional risk factors like weight, cholesterol and tobacco use and take depression and bipolar disorder into account, too. 

To understand more about this mind-body connection, Side Effects spoke with Benjamin Goldstein, a psychiatrist at Sunnybrook Health Sciences Center and the University of Toronto and lead author of the report. 

Side Effects: What is the connection between mood disorders and heart disease?

Benjamin Goldstein: The connections are multiple. We look at mood disorders as having dysfunction in brain reward systems, and for some people that could lead to seeking substances, and for some people that can lead to overeating. 

Then there's aspects attributable to medications, a lot of which give rise to weight gain. I think those are the obvious ones, and those are the culprits that get the lion's share of the attention to this point. 

What's less recognized is that there's a strong connection even among people who have never been treated, and even controlling for the usual risk factors like smoking and obesity. So that's what makes this especially compelling. 

SE: If you control for things like obesity and smoking, is there something else that explains the connection?

BG: So inflammation is the most obvious one. And that's also elevated during periods of depression and mania. So you can imagine that if somebody has a depressive episode for the last six months or a year, or has a number of manic episodes during the year, they're exposing their bodies to these extreme bursts of inflammation that are beyond normal physiology. That is likely to be harmful to blood vessels. 

SE: What kind of harm does it do to blood vessels?

BG: In normal physiologic responses, it's important to have inflammation. That's part of how we fight off infection, it's part of how we heal. 

But when that system is always “go” with no brakes and doesn't know when to turn off, that's when you start causing damage, and one of the places that damage can happen is the innermost lining of your blood vessels.  If that happens over a period of time with other conditions in place, you get this plaque buildup called atherosclerosis, and eventually, heart disease.

SE: At what point would you expect that to cause problems in one of these kids' lives?

BG: So think about a plumbing system. On the inside of a pipe you have a buildup of something. And then at some point, there's no way for water to get through. That's when you have your heart attack.

But that buildup process has been happening for decades, so already in adolescence, the process of that buildup is occurring, and the question is "How do we slow that process?" 

Traditional cardiovascular risk factors, if kept within normal ranges, can prevent heart disease. These are things that modifying them could offer benefits for these youth when they reach midlife, the peak time for them to have an early heart attack. 

SE: What do you recommend to help identify and mitigate these issues in teens?

BG: The real-life implications of this are that primary care physicians, nurses, anybody who's an allied health professional involved in the care of teenagers, should be recognizing that there's an important need to screen for body mass index, blood pressure, cholesterol and blood sugar, and make sure that teens with major depression or bipolar disorder are not getting out of balance in terms of the levels of those markers.

Jake Harper can be reached at jharper@wfyi.org or 317-614-0482. Follow @jkhrpr.