Psychiatrist Proposes New Subspecialty to Treat Patients With Depression and Heart Disease

Katie Eder

After finding abnormal elevations of cardiac inflammation in patients with depressive illness (DI), a psychiatrist at Loyola University Medical Center, in Maywood, Ill., has proposed a new subspecialty to diagnose and treat patients with both depression and cardiovascular disease (CVD).

After finding abnormal elevations of cardiac inflammation in patients with depressive illness (DI), a psychiatrist at Loyola University Medical Center, in Maywood, Ill., has proposed a new subspecialty to diagnose and treat patients with both depression and cardiovascular disease (CVD).

In a study presented at a joint congress of the World Psychiatric Association and International Neuropsychiatric Association in late November 2012, Angelos Halaris, MD, PhD, and five colleagues found greater concentrations of Interleukin-6 (IL-6) — an inflammatory protein produced in response to stress and associated with coronary artery disease (CAD) — in the blood of 48 patients diagnosed with major depressive disorder (MDD) compared to 23 healthy control subjects. Additionally, the researchers discovered the inflammation in the MDD patients failed to normalize despite a high rate of response to antidepressants escitalopram and quetiapine and an improvement in mood, and they found a “significant correlation between baseline IL-6 level and depression severity” as measured by the 7-Item Hamilton Depression Rating Scale.

According to Halaris, 40 percent to 60 percent of CVD patients have a clinical DI, and 30 percent to 50 percent of MDD patients are at risk of developing CVD, which reinforces his research findings that MDD patients have chronically elevated IL-6 levels that are closely linked to CVD.

“It is apparent that the relationship between DI and CVD is very complex. To address these complex questions, truly multidisciplinary teams of established investigators with diverse expertise in basic laboratory, clinical and cardiodiagnostic settings must come together,” Halaris writes in an article published in the April 28, 2009, edition of International Journal of Angiology. “Integrated teams of basic and clinical investigators possessing the requisite expertise have only recently begun to work collaboratively. It is only through the cohesive interaction of such multidisciplinary teams that we can succeed in unraveling the complex relationships between mental stress, inflammation, immune responses and DI, CVD and stroke.”

To jumpstart that collaboration, Halaris is proposing a multidisciplinary “psychocardiology” subspecialty to forge closer working relationships between psychiatrists and cardiologists, which he says will enable early detection of CVD risk in psychiatric patients and psychiatric illness in CVD patients, as well as provide physicians with continuing education on proper medication use in cardiac patients with psychiatric disorders.

Since age affects IL-6 levels — as his study found MDD patients under 39 years old registered higher concentrations of the protein — Halaris writes in his proposal “treating depression expertly and vigorously in young age can help prevent cardiovascular disease later on,” which he notes can be accomplished by formalizing teams of cardiologists and psychiatrists under a new subspecialty.

Abstract of study

Abstract of article