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After a heart attack 6 months ago, my father has been minimally interested informer activities and is afraid to go anywhere alone. Is this normal?

Depression and heart disease are increasingly being recognized as risk factors for one another. Just as smoking and high cholesterol increase one's odds of developing heart disease, so can the diagnosis of depression. Additionally, the risk of developing depression in the first year after a heart attack is dramatically greater than in the general population, going from 1 in 20 in the general population to 1 in 3 after a heart attack. Depression places a great deal of stress on the body. It can cause levels of stress hormones to rise, leading to increases in cholesterol, blood sugar, and arterial plaques. Depression can affect clotting factors, heart rate and rhythm, and blood pressure, all of which lead to increased chances for heart disease and heart attacks.

Treatment of depression in patients with known heart disease or known family histories of heart disease becomes even more critical for those reasons. Many antidepressants have been studied to determine their safety in cardiac patients after a heart attack and have been found to be as safe as in the general population. Some studies have demonstrated that some antidepressants such as the SSRIs can also directly cause platelet inhibition[1] similar to aspirin, thus adding another protective measure aside from their antidepressant effects. Currently, studies are underway to demonstrate whether treating depression lowers the rate of recurrent heart attacks, as preliminary studies have suggested. For all these reasons it is therefore imperative to get your family member into treatment if depression is suspected if he or she has heart disease or after a heart attack.

My mother has memory problems. Her doctor diagnosed pseudodementia and prescribed an antidepressant. Is she at risk for Alzheimer's disease?

Alzheimer's disease [2] Pseudodementia[3] is a term applied to older patients who initially present to their doctors complaining of memory problems but turn out to have depression. Many similarities exist between patients with dementia and pseudodementia, including apathy, anhedonia, energy disturbance, and sleep and appetite disturbances. In general, however, patients suffering from dementia do not overly complain about their poor memory. In fact, many are completely unaware that they have memory problems. Instead, they often accuse others of "playing with their heads" because they misplaced something and believe that someone has taken it. Patients with pseudodementia often complain bitterly about their loss of memory and frequently refer to themselves as "losing their minds" or "becoming demented." When tests of memory are performed in these patients, however, they demonstrate normal memory. The onset of the memory loss also varies, with patients suffering from pseudodementia having a more rapid onset of memory loss than those suffering from dementia.

Depression is four times more likely to occur in patients over 65 years than in those younger than 65 years.

Why does depression affect memory? Depression often leads to ruminations[4], which is a constant turning over of the same internal thoughts and feelings one can experience when suffering from depression. When locked into ruminations, it is very difficult to attend to the outside world. In addition, when you attempt to concentrate, the energy required for concentration leads to quick fatigue, causing you to be drawn back into your ruminations more easily. When attention and concentration are lost, the ability to input new memories is lost, and therefore, you experience this as a loss of memory. Although pseudodementia can be caused by depression, it can also be caused by prescription medications; even medications as seemingly benign as ibuprofen have been found to cause cognitive problems in the older population.

Depression is four times more likely to occur in patients over 65 years than in those younger than 65 years. The rates of dementia increase with age as well. Clearly, the rate of depression among patients with dementia is quite high, with approximately 20% to 30% of Alzheimer's patients suffering from depression in addition to their dementia. The link between dementia and pseudodementia was once thought to be weaker than it is considered now, and the diagnosis may actually be a harbinger for the development of dementia later on, although not from direct causation but rather because the dementia may first present as depression in some cases. In this age group it is often easy to dismiss symptoms as normal aging or as a normal reaction to the presence of multiple physical problems. This is potentially dangerous because the risk of suicide increases with age, particularly in men. Because most patients with pseudodementia respond well to treatment, identification and treatment of pseudodementia is imperative.

  • [1] referring to the inhibition of platelet activity, such as clotting. Some medications can cause interference in the platelet activity.
  • [2] a progressive disease of the brain characterized by a gradual loss of cognitive functions such as memory and reasoning. Personality and behavioral changes can accompany the disease as it progresses.
  • [3] literally, "false dementia." Depression in older persons can cause cognitive effects that mimic dementia. However, in pseudodementia, patients are often overly preoccupied with their cognitive loss relative to patients suffering from true dementia, who are often oblivious to their cognitive loss.
  • [4] obsessive thinking over an idea or decision.
 
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