Hit by Lightning
“If the thunder don’t get you then the lightning will.”
That song lyric popped into my head when I recently came across two oddly related news items on the same day. Here are the headlines:
From Reuters: Study: Antidepressants stop repeat heart attacks
From the Associated Press: FDA warns about antidepressants, suicide
Sometimes it seems like you just can’t win. But for those who suffer from depression following a heart attack, there’s a winning combination of nutrients that may successfully relieve depression while also improving heart health.
The telltale heart
Researchers at Stanford University recently examined how antidepressant drugs may affect mortality among heart attack survivors.
For about two and a half years, the Stanford team followed more than 1,800 patients who were diagnosed as depressed after a heart attack. Researchers calculated that patients who took antidepressants had a significantly lower risk of a recurrent nonfatal heart attack compared with those who didn’t take this type of drug.
Lead author of the study – C. Barr Taylor, M.D., of the Stanford University School of Medicine – told Reuters news service that he would, “recommend that any post-heart attack patient with depression be evaluated for treatment.”
But there’s a problem with that recommendation. If you ask someone who’s just had a heart attack if they’re depressed or blue or low (put it any way you like), you’ll probably get a “Yes” in return. After all, their heart has just attacked them. That’s enough to shake nearly anyone’s peace of mind.
Based on such a casual evaluation, many mainstream doctors would not hesitate to automatically write a prescription for an antidepressant. And while antidepressant drugs might achieve the desired effect on a patient’s mood and outlook, there are daunting adverse effects lurking as well.
Rolling thunder
Last year, the FDA issued a warning that adults and children who use the class of antidepressant drugs called selective serotonin reuptake inhibitors (SSRIs) may have an increased risk of suicide. After reanalyzing the results of hundreds of SSRI studies the FDA issued a second warning last month, cautioning doctors and SSRI users to watch closely for signs of suicidal behavior.
So, should a depressed heart attack patient risk the development of suicidal tendencies in order to reduce the risk of a second heart attack? Admittedly, the risk that SSRI use will trigger a suicide is small. But the risk of other side effects is not so small.
The known potential side effects of SSRI drugs include nausea, headache, anxiety, dry mouth, insomnia, sexual dysfunction, diarrhea and serotonin syndrome; a condition characterized by psychotic episodes. And in an e-Alert I sent you in 2001, I told you about a UK study that showed how SSRI use significantly increases the risk of upper gastrointestinal bleeding – especially in older patients.
The side effect on that list that perhaps seems most benign is dry mouth, a salivary gland dysfunction known as xerostomia among dentists. In another 2001 e-Alert, HSI Panelist Richard P. Cohan, D.D.S., wrote: “As a group, antidepressants cause more xerostomia than any other. And, as you may know, xerostomia leads to an increase in caries (cavities), periodontal disease, and candidiasis, a yeast infection in the mouth often referred to as thrush. While not everyone who takes antidepressants experiences these side effects, those who do are often left with serious, permanent damage.”
Heart friendly
As I’ve noted in previous e-Alerts, there are several nutrients that are known to help keep depression in check without triggering the powerful adverse side effects of SSRIs. For instance, high levels of B vitamins and magnesium have been shown to reduce depression symptoms. And both of these nutrients promote heart health as well.
Many studies have shown that omega-3 fatty acids also do double duty in preventing depression and heart disease.
In a 2003 study from the Netherlands, researchers examined blood samples from more than 260 elderly, depressed subjects and found what they called a “direct effect of fatty acid composition on mood.” Subjects with depressive disorders had a significantly higher ratio of omega-6 to omega-3 fatty acids compared to more than 400 randomly selected subjects.
And in an the e-Alert “Take it to Heart” (2/24/04), I told you about a study that analyzed 16 years of data, collected from more than 120,000 women. Researchers found that subjects in the group with the highest omega-3 intake had about half the risk of developing coronary heart disease compared to subjects in the group with the lowest intake.
Of course, that doesn’t necessarily mean that omega-3 intake will prevent a second heart attack. But you can be pretty certain you’ll never hear about someone committing suicide or suffering from gastrointestinal bleeding, anxiety, sexual dysfunction or xerostomia as a direct result of taking supplements of omega-3, magnesium and B vitamins.
Sources:
“Effects of Antidepressant Medication on Morbidity and Mortality in Depressed Patients After Myocardial Infarction” Archives of General Psychiatry, Vol. 62, No. 7, July 2005, archpsyc.ama-assn.org
“Study: Antidepressants Stop Repeat Heart Attacks” Reuters, 7/4/05, cnn.com
“FDA Warns About Antidepressants, Suicide” The Associated Press, 7/1/05, cnn.com
