Is Depression Linked to New-Onset Atrial Fibrillation Risk?

[Coco51]

This article based on a Korean study of more than 5 million participants found a significant link between low mood, depression and AF. Something I have often suspected, though anxiety maybe associatedin my case. The study has been widely reported and is also on Medscape.

jamanetwork.com/journals/ja....

[BobD Volunteer]

When I was patient representative on BHF committee for the arrhythmia nurse project some seventeen years ago, the phsycological aspect of AF was my hobby horse and I made myself as much of a nuisance as I could. Sadly such resources are sparse pretty much everywhere especially with the current pressures NHS is under.

[Coco51 in reply to BobD]

Sadly true. But great you had a chance to speak up!

[Heilung18-Gesund]

Interesting, but not a surprising observation. Depression is associated with pro-inflammatory activation. Similarly, atrial fibrillation, in part, is mediated by pro-inflammatory signaling, so inflammation would appear to be underlying both conditions. Therapeutic lifestyle interventions, such as meditation, yogic breathing, exposure to nature, exercise, an anti-inflammatory diet, good sleep etc over time may alleviate systemic inflammatory activation and both conditions.

TB

[Coco51 in reply to Heilung18-Gesund]

Yes. I thought this section was interesting. "The findings also help cement the bidirectional relationship between depression and AF, Garg noted.

"It's very clear that atrial fibrillation can lead to the development of depressive symptoms or depression because of the profound impact it has on patients' quality of life," he said.

He added that previous research has shown that patients with depression also have elevated levels of stress catecholamines ― and those chronically elevated levels are thought to be involved in the pathophysiology of developing AF."

[CDreamer]

I think that any serious health diagnosis affects people and we all handle it very differently however I think AF in particular has physical fight/flight responses which seem to affect people with no previous history of anxiety, so not surprised in the finding. Still astounded that it is still not more widely recognised and provided for though!

I noted this phenomena in myself when first diagnosed and wrote about it then quite extensively.

[Singwell in reply to CDreamer]

Absolutely spot on! My AF kicked off just before the pandemic. The two together triggered bouts of anxiety that I am still prone to even now. The downside of anxiety- meaning once the flight and fight is gone - is, alas, often depression. It then takes time and self-care to return to an even keel. Nowadays I treat anxiety as part of my ongoing lifestyle and self care.

[Coco51 in reply to Singwell]

Agreed. I certainly think dealing with my anxiety has helped my AF. I often wonder what would have happened if I had tackled anxiety at the start. But there's no re-wind option on life!

[JayDJ]

One might also wish to consider the effects of medication playing a part. Beta Blockers slow many of us down and whilst they might do a good job in slowing heart rates down, they can also bring lethargy with it. With lethargy it leaves many and certainly me thinking of what I used to be able to do - which is depressing and could lead to depression if one dwelled on it.

[CDreamer in reply to JayDJ]

So right. Beta Blockers also affect mood and it is well documented that they have the capacity to increase anxiety, although they used to be prescribed to help control anxiety. One of the first things I learned as a Psychotherapist was to always ask about medications and I soon noted an emerging pattern with anxiety and beta blockers.

[Coco51 in reply to CDreamer]

Gosh! How interesting. I've never heard that before!

[secondtry]

Low mood, depression, anxiety & I believe much more causes an eventual breakthrough which lets AF in.

One of the 'treatments' I prescribed for myself therefore was to cut out all existing & potential sources of anxiety (& its co-habitees), focus on other people whilst doing something that I was passionate about.

I think it has helped me stay AF free with no side effects and the fact it helps others is a bonus.

[Coco51 in reply to secondtry]

Good advice!

[Steve101 in reply to secondtry]

would be good if you could share more about your approach, I personally would like to hear how you have improved your life. I could well learn from you.

[Coco51 in reply to Steve101]

I can't speak for secondtry, but I had 8 sessions with a therapist I found through Anxiety.co.uk which worked very well. Whenever I felt the tension mounting I'd go and do deep breathing and play the recordings of our sessions which the therapist made and I have on my phone. They were all about getting things into perspective, stopping thinking the worst, stopping worrying about what other people think. But I don't need to so it do much any more I've joined various groups/organisations and spend time with people I really like.

[Steve101 in reply to Coco51]

well done you. I have been reading a book ‘why has nobody told me this before’ written by a therapist - really good book. Lots of tips and approaches to dealing with anxiety. Started meditation once a day for 30 mins. Appreciate you responding. Have a good day! Steve

[secondtry in reply to Steve101]

I will try and sum up briefly. I hadn't a clue what caused my AF at the beginning (my first episodes undiagnosed were around 2008), got a pretty good idea of the main culprits now though!

First you have to go through the mill of tests, high anxiety/depression, learning and finding the right medics. I had Lone PAF 'fortunately' but 9 episodes in a month, so then I had to decide quickly on 200mgs Flecainide or ablation, going for the former. Next I used my desire to come off the pills as a driver to make a multitude of lifestyle changes (many raised by members here), which I wouldn't otherwise have done - so hopefully less chronic illness later in life. Anxiety was also reduced by annual private appointments with the same cardiologist.

During this time I was lucky because I have had a lifelong interest in medical matters so trial and error on changes together with consulting Alternative Practitioners including a psychotherapist (suggested by my cardiologist) was not difficult. I was also lucky as having sold a business and received an inheritance, I reduced my financial worries and had the flexibility to develop a Not For Profit Social Enterprise at a sustainable pace that I was and still am passionate about.

In essence, I took a simplistic approach in the early days not knowing for sure what causes AF, I hit it with everything I could think of including the spiritual. Nowadays, 9yrs post diagnosis with AF in remission and still on the Flecainide, my main challenge is not to get complacent and let the lifestyle changes lapse (oh boy Guinness was good 😜) or be tempted to reduce the Flecainide.

Hope something in that longer than anticipated ramble helps.

[Steve101 in reply to secondtry]

very helpful thank you. 👍😀

[Ossie7]

Thanks for that link Coco51. It’s good to have some evidence for what I have always known as my first AF episode , which was persistent came on after a bout of clinical depression . I was 52 and female !!! It was also recurrent , so I fit the criteria to a tee !!!

[Coco51 in reply to Ossie7]

I hope you are better now. It's a long haul.My own AF kicked off just after I retired from a very fulfilling career, so I was adjusting to that (though I was not consciously anxious, I just came to recognise later that I was). It was paroxysmal.But it became persistent 10 years later. We had just moved house from our family home of 30 years - stressful obviously - when someone asked a favour of me which meant going to huge amounts of trouble - changing holiday dates, getting refunds and more ... In full people pleasing mode I didn't have the heart to say no. I now realise I began bottling up a lot of resentment. Silly me.

Anyway the AF started 24/7, with panic attacks to fuel it, and it didn't stop till I got treatment. I have now learnt to take notice of my own moods - and to say no when people are unreasonable !

[irene75359 in reply to Coco51]

I used to be a people-pleaser too, until my younger sister told me not to reply with an instant yes but rather "I'm not sure, can I get back to you on that?" The asker then often realises their request may be unreasonable, and most times never mention it again.

[secondtry in reply to irene75359]

"People pleaser' must be a common trait of many of us AFers, I am the same. I shudder to think what the psycho-analyst would make of us or maybe best to think we just have a kind character!! Seriously though it is a deep trap because anxiety can probably build unconsciously if you can't please your nearest & dearest.

[Coco51 in reply to irene75359]

That is such a good strategy!

[Ppiman]

I wonder whether it isn't linked to the common use of antidepressant drugs, especially perhaps SSRIs, to treat depression, since these can affect the heart's electrical system by causing a wider QT segment? I look forwards to reading this later - thank you!

Steve

[Coco51 in reply to Ppiman]

I hadn't heard that before, but I'm learning a lot of interesting things with this post!

[Ppiman in reply to Coco51]

I’ve sometimes wondered whether that might have happened to me but I’ll never likely now know. I was given those tablets a decade or more ago for anxiety when we lost several family members and friends in a very short period. They proved awful for me with major side effects.

Steve

[Coco51 in reply to Ppiman]

Those times of loss are awful, truly awful. I have never taken anti-depressants so I can't say, but I do know they don't suit everyone, while for others they can be life-saving. I read in the Times only this week in the Mark Porter column that some pretty good research has shown that - where depression is not life threatening (a very important proviso) - then anti depressants are often no better than a placebo. Can you open this link I wonder?

thetimes.co.uk/article/anti...

[Ppiman in reply to Coco51]

Thanks for the link. We take The Times but I missed that. He writes sensibly and helpfully.

I used to work in the pharmaceutical industry and know quite a bit about the drugs and the way they are heavily promoted; also the intense pressures from patients on their doctors to prescribe a tablet; and also the willingness of most doctors to do so.

This is despite most of the initial studies showing a less than wonderful effectiveness, with, if I recall, only about 35-40% showing “some or good improvement”; this also compares with a placebo response of about 30% (CBT “talking” therapies fare only a bit better 30-40%, I think, but very variable).

Few of the early studies were truly long term in the sense that depression can be long term. Also depression can be “reactive” and occur owing to circumstances; or “endogenous” or free-floating and occur willy nilly. This wasn’t always accounted for carefully in many studies that I remember reading.

Quite how so many SSRI and similar drugs ever came to be prescribed goes against human reason. How on earth they came to be so heavily prescribed to treat anxiety, when their effectiveness as anxiolytics has not truly been shown at all if I recall, defeats me. How they ever came to be prescribed to hordes of youngsters when studies show they cause suicidal ideation, God only knows.

That so very much has been written, even in peer-reviewed studies, let alone in the mass media, between doctors including the very best, and spoken between patients themselves, that is now provably wrong… well, it possibly provides a study in human folly (or desperation, or hope).

And yet depression is a problem that sometimes brings people deeply to feel the need to find a way out of it. Why we don’t cope with it now when we used to is another big question. Popping a pill, given to us by a trained and experienced professional whom we trust and rely upon for medical advice, and one who tells us it will surely help , is a reasonable thing to do.

But what a mess!

Steve

[Coco51 in reply to Ppiman]

Thank you for that insight. I have a relative considering her options with regard to depression, (not suicidal thankfully). Another friend who is struggling to come off anti-depressants. I will pass that on. Its too easy to start and too hard to stop.

As for why people used to cope with depression and now they don't...I wonder about that. Thinking back to adults I knew in my childhood and judging them now from my adult - geriatric-- point of view, I suspect that a great deal more self-medication with alcohol went on than we acknowledge. And further back in time with laudanum and opiates, like J Collis Brown's old formula linctus with morphine which was still available till the 1960s! (Now it's been modified however). That too deserves a study.

Thanks for your reply.

[Ppiman in reply to Coco51]

Well said. As I wrote that post, those past 'treatments' did occur to me, too. Maybe it was the arrival of insured healthcare (and the pharmaceutical revolution that followed that) which brought the issues we face today with the mass prescription of drugs?

The cause fascinates me. It might be the pressure of putting on a social persona in a society that admires 'strength' and abhors 'weakness'? I think so. Teens, especially, seem to be struggling with the need to seem 'cool'. I've many times taught Stevenson's novel, Dr Jekyll and Mr Hyde, and, although fiction, it seems clear that the Victorian obsession with public reputation and inner tensions was just as strong. Little has changed, and perhaps has even worsened.

It's all fascinating - and sad.

Steve