Major depressive disorder and coronary artery disease: a synergistic biopsychosocial phenomenon?

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Paul A Kudlow
Anna Chavlovski

Keywords

major depressive disorder, coronary artery disease, biopsychosocial, mental illness stigma

Abstract

Affecting an estimated 5-10% of the population at any given time, major depressive disorder (MDD) and coronary artery disease (CAD) are common, yet debilitating illnesses. Although traditionally viewed as separate disorders, it has been estimated that up to 20% of patients diagnosed with CAD also suffer from clinical depression. Here we report that the link between CAD and MDD extends well beyond a coincidental association. A review of the extant literature suggests that MDD is a strong independent risk factor in development of CAD. Robust scientific evidence has shown that MDD induces a myriad of pathophysiologic changes in the body (autonomic dysregulation, endothelial and platelet dysfunction etc) increasing the risk of developing CAD. Given the evidence, one would think that patients with MDD would receive special attention but, paradoxically, the opposite happens in practice. A growing body of literature suggests that patients diagnosed with MDD and various other mental health conditions may be seeing the effects of a pervasive social stigma, often leading to failure of primary and secondary prevention of CAD in this population group. Herein we propose a noxious biopsychosocial synergy that serves to explain why patients with MDD are at substantially higher risk to develop CAD. Healthcare providers must be educated and sensitized to this topic; only then do we stand to reduce the high morbidity and mortality in this vulnerable yet marginalized patient population.