Major depression and bipolar disorder are among the most common mental disorders among young people, and new research suggests the long-term health consequences of these disorders could be more severe than once thought. According to a scientific statement released this week by the American Heart Association, both depressive and bipolar disorders put teenagers at heightened risk for premature heart disease and should be considered as independent risk factors for the condition.
This means clinicians should closely monitor all young patients with mood disorders regardless of medication use, according to the statement, which was published in the journal Circulation as an update to 2011 recommendations from an AHA panel on cardiovascular health and various pediatric conditions.
“Youth with mood disorders are not yet widely recognized as a group at increased risk for excessive and early heart disease. We hope these guidelines will spur action from patients, families and health care providers to reduce the risk of cardiovascular disease among these youth,” Dr. Benjamin Goldstein, a child-adolescent psychiatrist at Sunnybrook Health Sciences Center at the University of Toronto, said in a heart association news release.
Major depression and bipolar disorder are common mood disorders, affecting about 10 percent of U.S. adolescents. Worldwide, major depression is the leading cause of disability among teens, while bipolar disorder is the fourth-leading cause.
Previous studies have shown that adults with depressive and bipolar disorders have higher rates and earlier onset of cardiovascular disease, but few studies have looked at the problem in young people. However, since cardiovascular disease is a chronic condition that can start in early life, Dr. Goldstein’s team wanted to see if the same pattern observed among adults also emerged in teens.
For the study, Dr. Goldstein and his colleagues reviewed published research and found that teens with major depression or bipolar disorder were more likely than other teens to have: high blood pressure; high cholesterol; obesity, especially around the midsection; type 2 diabetes; and hardening of the arteries.
A 2011 study included in the review looked at more than 7,000 American adults younger than 30 and found that a history of depression or attempted suicide was the top risk factor for heart disease death caused by narrowed/blocked arteries in young women; it was the fourth highest risk factor in young men. This is in line with previous research, which has found that the effects of psychological stress on the heart are more severe in women than in men, even among young women. Other studies have shown that young women with high levels of stress have worse recovery after heart attack than men with similar levels of stress.
The reasons for this increased risk in young people are unclear. It’s known that teens with mood disorders are more likely to have unhealthy habits such as smoking, drug use and physical inactivity, but these factors alone do not explain why they are more likely to develop heart disease, the researchers said. And although some medications used to treat mood disorders can cause weight gain, high blood pressure, high cholesterol and high blood sugar levels, most of the teens in the studies included in the review were not taking these medicines.
The researchers also point to previous studies that have linked mood disorders in adolescence with inflammation and other types of cell damage, which could provide a possible biological explanation for the findings.
Regardless of the reason for the increased risk, Dr. Goldstein says the new findings should serve as a wake-up call that these disorders take their toll on heart health, even from a young age. While modifying conventional risk factors such as cigarette smoking, high blood pressure, obesity and diabetes is still key to preventing heart disease, the role of mental health should not be overlooked, the researchers say. In fact, evidence suggests that up to one-third of heart disease cases could be attributable to the adverse effects of psychosocial stressors and poor mental health.
“Mood disorders are often lifelong conditions, and managing cardiovascular risk early and assertively is tremendously important if we are to be successful in ensuring that the next generation of youth has better cardiovascular outcomes,” Dr. Goldstein said. “These disorders indicate an increased risk of heart disease that requires increased vigilance and action at the earliest possible stage,” he concluded.