Prescribe Aspirin For Depression?

The Question

Cardiologists usually  recommend that people who have a history of coronary artery disease or peripheral artery disease should take aspirin which has anti clotting qualities. This  is also often recommended for people who are in a high risk group for such conditions. In fact many doctors recommend that people who are in low risk group should take one baby aspirin per day as a preventative especially if they are in an age group where these conditions are more prevalent. Emergency first aid for a person who has the symptoms of a heart attack could be to take two regular aspirins while waiting for the ambulance or while on the way to the hospital.

If  people who have depression are more likely to develop coronary heart disease and more likely to have a heart attack should this group also be advised to take a baby aspirin as a preventative measure?

What Do We Know

In order to consider this question, let’s take a look at what we know about heart disease and depression.

Analysis of research data points to the fact that depression is an independent risk  factor for coronary artery disease  in both men and women  when other cardiovascular risk factors are controlled.

Patients with a history of recurrent depression have a four to five times increased mortality rate at 6 month follow-up after a heart attack than those without depression

Premorbid depression is associated with poor outcome in patients who had a post coronary artery bypass graft, this includes complications of congestive heart failure, and even death.

Depression after a heart attack was associated with increased risk of another heart attack and death.

Decreased serotonin associated with depression appears to cause changes in platelet stickiness, which leads to clotting and blocking of blood vessels.

The connection between depression and heart disease can stand on its own. However depression also interacts with other known risk factors , making it more likely that people with depression will have a heart attack . Some of these interactions are as follows:

Smoking- There is often increased smoking with depression

Hypertension- Stress including depression can elevate blood pressure

Obesity- People with chronic depression often overeat

Diabetes- People with depression have an 2x increased chance to develop diabetes

Excessive Alcohol Use – Depression and excessive alcohol use reinforce each other

Family History of Premature Death from Heart Disease – Leads to depression & the     Nemesis Complex

I have discussed these factors in a previous blog

Logical Conclusion

It does appear that having depression increases the risk of having a heart attack whether it is directly or by interaction with other risk factors. Therefore it does seem logical that aspirin, as a preventive measure, should be advised when depression is diagnosed. Obviously the depression should be fully evaluated and treated. This may involve antidepressant, psychotherapy or both forms of treatment. Depression can completely disrupt a person’s life as well as that of their family and the people who are close to them. Depression can also lead to tragic suicidal behavior.

Before instituting any use of aspirin on a regular basis this plan should be discussed with your internist, family physician or cardiologist. There are some conditions such peptic ulcer disease or various bleeding disorders, which can be made worst by aspirin. There also may be drug interactions or synergies, which need to be avoided

The discussion and consideration of the use of aspirin as part of the treatment plan for depression could accomplish two important purposes. It might decrease the chance of these seriously medical conditions. It would also raise the awareness of the public about the far reaching effects of depression on physical health in addition to the well known  impact on mental health and the ability to function.