Psychotherapy's Hidden Bonus: Healthier Hearts
Treating depression with talk therapy may provide protection against heart disease, new research suggests.
As depression lifts, people may begin to engage more in healthy eating and exercise, investigators believe.
In a study of nearly 637,000 people who took part in talk therapy offered by the United Kingdom's National Health Service (NHS) between 2012 and 2020, those whose depression symptoms improved were 12% less likely to develop cardiovascular disease, including coronary heart disease, stroke and death, researchers found.
"It is the first time that such a link is established; however, it is important to note that our study does not prove a causal effect, namely that the lower likelihood of developing cardiovascular disease is caused by the psychological therapy," said lead author Celine El Baou, a research assistant at the Dementia Research Center of University College London.
More research is needed to understand these findings better and the mechanisms involved, which could be biological or linked to lifestyle behaviors, she said.
Globally, cardiovascular diseases such as stroke and heart disease are the No. 1 cause of death, claiming 18.6 million people worldwide in 2019, according to the study.
"The study suggests that talking therapies for depression may also help in reducing the future risk of cardiovascular disease," El Baou said. "So it is important that therapies are made as effective and accessible as possible."
Talking Therapies is a program to treat anxiety and depression offered by the NHS. It takes aim at mental health problems that affect an estimated 1 in 4 adults every year. According to the NHS, mental health problems are the largest single cause of disability in the U.K.
The program is free and offers cognitive behavioral therapy, counseling and guided self-help.
Depressive symptoms were measured using a questionnaire that considers such factors as sleep issues, lack of interest in doing things and low mood. These findings were then linked to patients' health care records to look for heart events.
The new study also uncovered a link between age and benefit from talk therapy.
People under age 60 whose depression eased after talk therapy had a 15% lower risk of heart disease and a 22% lower risk of premature death from all causes, the study found.
Patients over 60 saw a smaller benefit. Their risk for heart disease dropped 5% and they had a 14% lower risk of early death from other causes.
Dr. Scott Krakower, a psychiatrist at Zucker Hillside Hospital in Glen Oaks, N.Y., reviewed the findings.
"We've known that having depression is a potential risk factor for and possible worsening of cardiovascular disease," he said.
In Krakower's view, the best treatments for depression combine medication and talk therapy.
"Therapy is important because you have targeted symptoms, and you have a one-on-one meeting where you can express yourself and work through things that sometimes the medication won't do," he said.
"We do also recognize that medication is a mainstream treatment for depression -- the idea that you have formed a relationship with someone you can open up to is something you can't do with a pill," Krakower added.
Treating depression can spur lifestyle improvements that benefit overall health, he said.
For example, a more positive attitude can lead to eating healthier and exercising, which can improve overall and heart health in particular.
"If you're feeling anxious or increasingly depressed, you should definitely seek out treatment," Krakower said. "It'll open doors. You'll have a better understanding of yourself and you will be more likely to open up and be more receptive to changing your lifestyle."
The study was published online April 18 in the European Heart Journal.
For more on depression and heart disease, see the American Heart Association.
SOURCES: Celine El Baou, MSc, research assistant, Dementia Research Center, University College London, U.K.; Scott Krakower, DO, psychiatrist, Zucker Hillside Hospital, Glen Oaks, N.Y.; European Heart Journal, April 18, 2023, online