Treating depression through talking therapy could help cut the risk of heart disease, a new study suggests.
There are a number of different talking therapies, including guided self-help, where a therapist coaches patients through a self-help course, and counselling for depression.
Cognitive behavioural therapy (CBT) – based on the idea that thoughts, feelings, what we do and how our bodies feel physically are all connected – is another example, the NHS said.
This study is the first to establish a link between psychological therapy outcomes and future risk of cardiovascular disease— Celine El Baou, lead author
The new research found that using these therapies to effectively treat depression in adults over 45 may be linked with reduced rates of future heart disease.
In the first-of-its-kind study, researchers looked at whether psychological therapies, such as CBT, used to treat depression could play a role in reducing the risk of developing cardiovascular disease – including stroke and heart disease – later in life.
Previous studies have shown that people who experience depression are around 72% more likely to develop cardiovascular disease in their lifetime than those who do not.
Lead author, PhD candidate at University College London Celine El Baou, said: “This study is the first to establish a link between psychological therapy outcomes and future risk of cardiovascular disease.
“The findings are important as they suggest that the benefits of psychological therapy may extend beyond mental health outcomes and to long-term physical health.”
“They stress the importance of increasing access to psychological therapy to under-represented groups, for example minority ethnic groups who may be more at risk of experiencing cardiovascular disease.”
This study shows that successful treatment of depression using psychological therapies is associated with lower subsequent risk of heart and circulatory diseases, including heart attacks and strokes— Professor Sir Nilesh Samani
In the new study, researchers analysed data from 636,955 over-45s who accessed treatment via England’s national Improving Access to Psychological Therapies (IAPT) service, between 2012 and 2020.
This is soon to be called NHS Talking Therapies for anxiety and depression.
The free service offers CBT, counselling and guided self-help, with sessions delivered either face-to-face individually or in groups online.
A questionnaire, which considers factors such as a lack of interest in doing things, issues with sleep and feelings of low mood, was used to measure depressive symptoms.
Researchers then linked the IAPT outcomes (depression scores) with patients’ health records to look for new incidence of cardiovascular events.
They found that people whose depression symptoms improved after psychological treatment were less likely to develop cardiovascular disease over an average of three years of follow up, compared to those who did not.
The study also suggests that reliable improvement from depression (compared to no reliable improvement) was associated with a 12% decrease in future cardiovascular disease at any given time.
Similar results were observed for coronary heart disease, stroke and death.
Although this link is already known, patients with cardiovascular disease often are not formally assessed for depression, while the risk of heart disease in depressed people is also often overlooked— Professor Tim Chico
The association was stronger in people aged under 60, who had a 15% decreased risk of cardiovascular disease and 22% decreased risk of death from all causes respectively.
Meanwhile, those over the age of 60 had a 5% decreased risk of developing cardiovascular disease and 14% decreased risk of death from all other causes, researchers found.
The researchers point out a number of limitations of their study, including that they had little information about lifestyle, such as exercise or smoking habits.
They suggest another explanation for the results could be that those who respond to psychological therapy had lifestyle behaviours that were more protective of cardiovascular disease in the first place.
The dataset used in the study, published in the European Health Journal, was funded by Alzheimer’s Society.
Professor Sir Nilesh Samani, medical director of the British Heart Foundation, said: “This study shows that successful treatment of depression using psychological therapies is associated with lower subsequent risk of heart and circulatory diseases, including heart attacks and strokes.
“While observational, it provides further evidence that brain and heart health are connected, and that treating depression may have other significant benefits beyond improving mental health.”
Tim Chico, professor of cardiovascular medicine and honorary consultant cardiologist at the University of Sheffield, said the study underlines the “important link between depression and cardiovascular disease”.
We need to consider how to improve detection and treatment of depression, not just because it is important in itself but because it may also reduce the burden of heart disease to a similar extent as other treatments for heart disease— Professor Tim Chico
He added: “Although this link is already known, patients with cardiovascular disease often are not formally assessed for depression, while the risk of heart disease in depressed people is also often overlooked.
“The study does not prove that treating depression using talking therapies reduces risk of later heart disease, though it suggests that it might.
“Although proving such a link would need a randomised clinical trial where depressed people are randomised to receive treatment or not, such a study is unlikely to be ethical.
“We need to consider how to improve detection and treatment of depression, not just because it is important in itself but because it may also reduce the burden of heart disease to a similar extent as other treatments for heart disease.”
