Damned if you do… – heart attacks and anti-psychotics

I have severe depression, and I have had a heart attack. Yes, my father was only in his mid-fifties when he had his first, so I had some genetics against me. However, I had also been taking anti-depressants and anti-psychotics for years before my attack. of course, there have always been people who have decided that such medications are harmful to my health and I should avoid them. I’ve always declared that without my drugs, I would likely have killed myself before now, but the question remains – is there anything more to the effects of these medications and depression? The answer is yes, but in different ways.

First we look at one side:

 Metabolic and cardiovascular adverse effects associated with antipsychotic drugs Marc De Hert, Johan Detraux, Ruud van Winkel, Weiping Yu & Christoph U. Correll Nature Reviews Endocrinology 8, 114-126 (February 2012)

Antipsychotic medications can induce cardiovascular and metabolic abnormalities (such as obesity, hyperglycemia, dyslipidemia and the metabolic syndrome) that are associated with an increased risk of type 2 diabetes mellitus and cardiovascular disease. Controversy remains about the contribution of individual antipsychotic drugs to this increased risk and whether they cause sudden cardiac death through prolongation of the corrected QT interval. Although some drug receptor-binding affinities correlate with specific cardiovascular and metabolic abnormalities, the exact pharmacological mechanisms underlying these associations remain unclear. Antipsychotic agents with prominent metabolic adverse effects might cause abnormalities in glucose and lipid metabolism via both obesity-related and obesity-unrelated molecular mechanisms. Despite existing guidelines and recommendations, many antipsychotic-drug-treated patients are not assessed for even the most easily measurable metabolic and cardiac risk factors, such as obesity and blood pressure. Subsequently, concerns have been raised over the use of these medications, especially pronounced in vulnerable pediatric patients, among whom their use has increased markedly in the past decade and seems to have especially orexigenic effects. This Review outlines the metabolic and cardiovascular risks of various antipsychotic medications in adults and children, defines the disparities in health care and finally makes recommendations for screening and monitoring of patients taking these agents.

So it appears there may be a connection. The question is raised – are anti-psychotics harmful to your health? But then, besides mitigating some of the most serious effects of mental illness, are they too dangerous to take? here’s another look from Norway.

We found a dose-response relationship between depressive symptoms and the risk of developing heart failure,” said Lise Tuset Gustad, first author of the study and an intensive care nurse at Levanger Hospital in Norway. “That means that the more depressed you feel, the more you are at risk.”

The study used data collected during the second wave of a large epidemiological study in Nord-Trøndelag county, Norway, called the Nord-Trøndelag Health Study (HUNT study). Nearly 63,000 of the 97,000 residents in the county agreed to take part in the study.

One of the largest and longest longitudinal studies in the world has found a direct dose response connection between the severity of depression and the likelihood of a cardiac event.

So, there it is. Treating my depression can lead to heart attacks. Not treating my depression can also result in my death. Medications may not be particularly effective in treating milder forms of depression, but as severe depression requires more aggressive treatment.

What does all this mean? Modern medicine has kept me alive.

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