Gloom isn’t good for your mind, but it isn’t good for your heart, either: It can lead to heart disease, even do in your heart after coronary bypass surgery.

So, at least, imply three studies reported in March at the annual meeting of the American Psychosomatic Society in Savannah, Ga.

Certainly depression has already been known to increase the chances of dying prematurely. And so has heart disease. In fact, as a recent provocative finding in seniors revealed, depression may hasten the way to the Grim Reaper via a heart attack. And now still more evidence along these lines comes from Paul J. Rowan, a graduate student in the department of psychology at the University of Alabama in Tuscaloosa, and his colleagues.

Their study included 2,900 persons who had already participated in the Nova Scotia Health Survey in Canada. These individuals had already been measured for symptoms of depression by the Centers for Epidemiological Studies-Depression (CES-D) scale and had given Rowan and his coworkers permission to scrutinize their medical records. Rowan and his team expected that subjects who had been depressed would subsequently be more likely to be hospitalized for heart disease–related problems than subjects who had not been depressed. And their hypothesis was borne out by what they found: Persons who had had heightened levels of depressive symptoms (a CES-D greater than 26) were twice as likely as those with lower levels of depressive symptoms to have had, subsequently, at least one heart disease–related hospitalization.

So, if one accepts from such evidence that depression can really harm the heart, how does it happen physiologically? When people are depressed, they nearly always have low levels of serotonin in their brains—at least as far as researchers have been able to tell. What’s more, stress is known to contribute to heart disease. There is still another known: Two proteins produced by white blood cells—interleukin 1 alpha and tumor necrosis factor alpha—appear to be culprits at the start of the hardening-of-the-artery process. Mostly animal studies implicate them, but some human autopsy results do too. In short, while the proteins probably don’t contribute to hardening of the arteries in all circumstances, they may well do so in others, Montaz Wassef, Ph.D., director of the Atherosclerosis Research Group at the National Heart, Lung, and Blood Institute in Bethesda, Md., told Psychiatric News.

Thus Edward Suarez, Ph.D., a psychologist with Duke University Medical Center in Durham, N.C., and his coworkers wondered whether low levels of serotonin in the brain, combined with stress, might activate interleukin 1 alpha and tumor necrosis factor—putatively bad players in the arteriosclerotic process.

First they analyzed 56 subjects to see whether they had low, normal, or high levels of serotonin and measured their blood levels of interleukin 1 alpha and tumor necrosis factor alpha. The subjects were then asked to recall events in their lives that made them sad or angry.

After each recollection their blood was again examined for levels of interleukin 1 alpha and tumor necrosis factor alpha. Subjects with normal or high serotonin levels, Suarez and his team found, showed no increase in the levels of the two proteins after recalling sad or angry events. But subjects—especially men—with low serotonin levels did.

The two studies conduced by Rowan, Suarez, and their coworkers, of course, make one wonder: Might taking antidepressants that boost serotonin in the brain—the SSRIs—fend off heart disease in depressed persons? Researchers have not yet tested this tantalizing possibility, Suarez told Psychiatric News, but he hopes that he and his colleagues will be able to.

Now, let’s say you’ve experienced a heart attack, yet coronary bypass surgery has saved your life. You’re home free, right? Wrong, if you experience depression after the surgery, still the third study reported at the psychosomatic meeting implies. This one was headed up by Ingrid Connerney, R.N., Ph.D., director of clinical effectiveness at the University of Maryland Medical Center in Baltimore.

The study included 309 patients who had had bypass surgery at the medical center in Baltimore. The researchers wanted to know whether depression prior to leaving the hospital might play a role in how well the patients would do within a year following surgery.

To find out whether subjects were depressed before leaving the hospital, Connerney gave each a psychiatric interview that was the depression section of the diagnostic interview schedule, created for the National Institutes of Health Collaborative Study of Depression. It basically asks questions about the symptoms listed in APA’s Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).

Twenty percent of the subjects were depressed, Connerney and her colleagues found. What’s more, the depressed subjects were three times more likely to experience a heart problem within the subsequent 12 months than were subjects who were not depressed. Such problems included chest pain, heart failure requiring hospitalization, a heart attack, and the need for another cardiac procedure. Depressed women subjects were especially at risk for such subsequent difficulties.

Peter Shapiro, M.D., a psychiatrist with Columbia University College of Physicians and Surgeons in New York City, was a coauthor of this study. When asked what are the implications of its results for psychiatrists, he told Psychiatric News: "We don’t know for certain whether or not treating depression in these patients would have an effect on their cardiovascular morbidity, but we think that is an important question for us to know about—that it is possible that psychiatrists should be actively looking to treat these patients because we could improve their medical outcome. . . ."