Heart Disease and Depression

We are writing to applaud Dr. Carolyn Robinowitz's president's column in the january 4 issue. We are particularly pleased with the efforts APA is making to initiate communication with the American Heart Association on the role of depression as a risk factor in cardiovascular disease.

A collaborative approach by cardiologists and psychiatrists for management of cardiovascular disease is a promising and welcome development. Whereas research into possible common biological mechanisms of comorbid cardiovascular disease and depression will eventually find novel therapeutic modalities, more data are needed to verify the preliminary findings of the beneficial effects of currently used antidepressants regarding the prevention of and recovery from cardiovascular disease. Comprehensive prospective studies are under way addressing this important practical issue.

Interestingly, recent national studies of gorilla health have identified an unsuspected group of subjects that might be at risk for comorbid depression and heart disease. Early this year, two Cleveland Zoo gorillas were diagnosed with heart disease and are going to be pharmacologically treated for this illness. Captivity has been known to cause behavioral distress in animals, and a number of psychotropic drugs have been used in zoos to deal with these problems. A case in point is the female gorilla Johari from the Toledo Zoo. Johari first received treatment with a selective serotonin reupdate inhibitor in 2002 to help her integrate into a group. When medication was temporarily stopped, Johari suffered the original debilitating behavioral problems. Since then, she has been on antidepressant therapy and apparently has been doing well.

It is tempting to speculate that similar molecular mechanisms are at play in both humans and gorillas that link behavioral pathologies and cardiovascular disease. If ongoing clinical studies confirm the preventive action of antidepressants in subjects at risk for depression and heart disease comorbidity, gorillas might benefit as well. Or perhaps, could it be the other way around?