For years cardiologists and mental health experts have known that depression raises risk for heart attack by 50 percent or more.

But what hasn’t been clear is why depressed people have more heart problems. Does depression cause some biological change that increases risk? Does the inflammatory process that leads to heart disease also trigger depression?

The answer may be far simpler. A new study suggests that people who are depressed are simply less likely to exercise, a finding that explains their dramatically higher risk for heart problems.

Researchers, led by doctors from the Veterans Affairs Medical Center in San Francisco, recruited 1,017 participants with heart disease to track their health and lifestyle habits. As they expected, those patients who had symptoms of depression fared worse. About 10 percent of depressed heart patients had additional heart problems, during the study, compared with 6.7 percent of the other patients. After controlling for other illnesses and the severity of heart disease, the finding translates to a 31 percent higher risk of heart problems among the depressed people, according to the study published this week in the Journal of the American Medical Association.

But once the researchers factored in the effect of exercise, the difference in risk among depressed people disappeared. In the same study, patients who didn’t exercise, whether or not they were depressed, had a 44 percent higher risk of heart problems, after controlling for a variety of factors including medication adherence, smoking and other illnesses.

The findings are important because some earlier studies have suggested a link between antidepressant use and lower heart risk. The explanation may be that patients who take antidepressants start to feel better and take care of themselves, adopting healthy behaviors including exercise. In a study of nearly 2,500 heart-attack patients, published in the Journal of the American Medical Association in June 2003, behavioral therapy to treat depression didn’t change survival rates compared with patients who received regular care. But among about 20 percent of patients in the study who ended up on antidepressants, the risk of dying or suffering a second nonfatal heart attack was 42 percent lower. Another study, called Sadheart (which stands for Sertraline Antidepressant Heart Attack Randomized Trial) showed the death rate from heart-related problems was 20 percent lower among patients taking the drug, although the data weren’t statistically significant.

The research suggests that doctors treating patients for depression should also talk to them about their lifestyle habits, and encourage them to exercise. The findings, say the researchers, suggest that the heart problems associated with depression “could potentially be preventable.”

The evidence that health behaviors fully explain the link between depression and heart disease in this study is convincing, says Dr. Mary A. Whooley, professor of medicine, epidemiology and biostatistics at the University of California, San Francisco. However, she notes the study is limited to older men with stable coronary disease, and as a result, more study is needed of women and other patients with heart disease.

It remains an open question whether the study findings will change the way doctors counsel their patients. “The clinical practice question is a challenging one,” says Dr. Whooley. “It’s easy for us to tell patients to exercise, take their medicines, and refrain from smoking, but actually changing health behaviors is very difficult.”

Douglas Prasher, who discovered the glowing jellyfish protein used in research that won a Nobel Prize, now drives a courtesy van for a car dealer in Huntsville, Ala. (Bryan Bacon/The Huntsville Times)

Anyone who has struggled with depression — either in themselves or a loved one — will be moved by the story of Douglas C. Prasher.

Dr. Prasher, who now drives a courtesy van for a car dealer, abandoned a life of scientific research years ago. Trained as a biochemist, Dr. Prasher has struggled over the years with bouts of depression.

His story wouldn’t be notable except for a startling fact: his early research led to a Nobel Prize-winning discovery about the inner workings of living cells. Read more…

Phone-based therapy can be less hassle for patients. (Peter DaSilva for the New York Times)

Most therapists schedule face-to-face meetings with their patients. But new data suggest that therapy by phone may be a better option for some patients.

It has long been a concern among therapists that nearly half of their patients quit after only a few sessions. As a result, a number of health care providers and employee-assistance programs now offer therapy services by phone.

A new analysis of phone therapy research by Northwestern University shows that when patients receive psychotherapy for depression over the phone, more than 90 percent continue with it. The review of a dozen studies of phone therapy showed that the average attrition rate in the telephone therapy was only 7.6 percent, compared to nearly 50 percent in face-to-face therapy. The researchers also found that telephone therapy appeared to be just as effective at reducing depressive symptoms as face-to-face treatment. Read more…

Viagra doesn’t work as a treatment for women, most studies show. But new research suggests that among women who suffer sexual side effects as a result of antidepressants, the little blue pill may help.

Sexual side effects due to antidepressant treatment are common, affecting from 30 percent to 70 percent of men and women who use the drugs. In the first month of treatment, about two out of three patients will stop using antidepressants, often citing sexual side effects as a reason.

In a new study, researchers studied the effects of Viagra and a placebo in 98 women, average age of 37, who were using antidepressants for major depression. All the women also reported sexual side effects like lack of arousal or difficulty achieving orgasm. For eight weeks, the women took either Viagra or a placebo pill one to two hours before having sex. Read more…

Bipolar disorder (Rob Bennett, Nathaniel Brooks, Steven Kagan, Jeffrey Sauger, Brendan Smialowski, Lori Waselchuk for The New York Times)

I have long admired the bravery and selflessness of patients who are willing to tell their personal health stories. Today, “Patient Voices,” created by my colleague Karen Barrow, gives a voice to bipolar disorder, featuring nine courageous people who share their own stories of diagnosis, treatment, struggle and acceptance.

You’ll meet 42-year-old Carter Goodwin of Beacon, N.Y., whose honesty about his disease will move you. “I miss the mania,” said Mr. Goodwin, an artist. “I love the mania. It feels so good to feel like I can do anything and like there is something really special about me. But it’s all chemical. It’s not true.”

And there’s Jacqueline Castine of Bloomfield Hills, Mich., who talks of “coming to the very end of myself” before she was diagnosed at the age of 57 with bipolar disorder. Sadly, Ms. Castine’s son also suffered from mental illness, and killed himself.

“I could not save him,” she said. “I could not fix him. He leaves a beautiful daughter and a very sad mother.”

And there’s Victoria Maxwell, 41, from Vancouver, British Columbia, who talks about the challenges she faced while dating and deciding whether to disclose her illness.

“I really wrestled with when do you tell somebody,” said Ms. Maxwell, who is now married. “Generally speaking I would let them get to know who I am, and if they didn’t like me for me, I couldn’t chalk it up to having bipolar disorder.”

Whether your life has been touched by mental illness or not, you will find the stories shocking, heartbreaking and hopeful. To hear the voices of bipolar disorder, click here.

And please, share your comments below.

The D.S.M. is used to diagnose a wide range of mental disorders. (Cary Conover)

More than half of the task force members who will oversee the next edition of the American Psychiatric Association’s most important diagnostic handbook have ties to the drug industry, reports a consumer watchdog group.

The Web site for Integrity in Science, a project of the Center for Science in the Public Interest, highlights the link between the drug industry and the all-important psychiatric manual, called the Diagnostic and Statistical Manual of Mental Disorders. The handbook is the most-used guide for diagnosing mental disorders in the United States. The guide has gone through several revisions since it was first published, and the next version will be the D.S.M.-V, to be published in 2012.

The American Psychiatric Association’s Web site has posted the financial disclosure of most of the the 28 task force members who will oversee the revision of the D.S.M.

It’s not the first time the D.S.M. has been linked to the drug industry. Read more…

Working with farm animals may boost coping skills. (James Estrin/The New York Times)

Caring for farm animals appears to offer a therapeutic benefit for people with mental illness, according to new research.

Earlier studies with cats and dogs have shown that animal-human interaction can decrease stress and improve self-confidence and social competence. But less is known about whether working with other types of animals offers any benefits to those struggling with anxiety or other psychiatric disorders. Even so, the use of farms to promote mental health is increasing in Europe and the United States, as various treatment programs offer so-called “green” care, which includes time in community gardens and on farms as a form of therapy. Read more…

Emotional and personality traits have long been associated with heart disease. Now researchers have shown that the combination of two traits — hostility and depression — may exact a particularly risky toll on the heart.

Depression and hostility commonly occur together, doctors say. But when a person is both depressed and hostile, the traits interact in a complex way to elevate inflammatory proteins in the human body, reports lead researcher Jesse Stewart, assistant professor of psychology at Indiana University-Purdue University Indianapolis. The combination of hostility plus depression appears to be as dangerous a risk factor for heart disease as high blood pressure or even smoking. Read more…

The midlife crisis, a time of self-doubt and turmoil familiar to many in their 40s and 50s, is often viewed as a phenomenon of Western culture. But new research suggests that people all over the world are miserable in middle age.

Those are the surprising findings from a worldwide study of two million people from 80 countries. The researchers, economists Andrew Oswald from the University of Warwick in England and David Blanchflower from Dartmouth College in the United States, found that happiness levels followed a U-shaped curve, with happiness higher towards the start and end of our lives. Across cultures, they found, depression and unhappiness typically strike people in midlife.

The findings are important because other studies have suggested that psychological well-being stays relatively flat and consistent as people age, the researchers said. The latest report, to be published in Social Science & Medicine, analyzed information from several sources. Data was collected from 500,000 randomly sampled Americans and West Europeans from large surveys. The authors also analyzed data on the mental health levels of 16,000 Europeans, the depression and anxiety levels among a large sample of British citizens, and data from “The World Values Survey,” which provides samples of people in 80 countries.

The researchers found that for both British men and women, the probability of depression peaks around 44 years of age. In the United States, unhappiness peaks at around age 40 for women and 50 for men. Read more…

An uplifting result of music therapy. (Alan Zale for The New York Times)

Many people find that music lifts their spirits. Now new research shows that music therapy — either listening to or creating music with a specially trained therapist — can be a useful treatment for depression.

The finding that music therapy offers a real clinical benefit to depression sufferers comes from a review by the Cochrane Collaboration, a not-for-profit group that reviews health care issues. Although there aren’t many credible studies of music therapy for depression, the reviewers found five randomized trials that studied the effects of music therapy. Some studies looked at the effects of providing music therapy to patients who were receiving drug treatment for depression. Others compared music therapy to traditional talk therapy. In four out of five of the trials, music therapy worked better at easing depression symptoms than therapies that did not employ music, the researchers found.

“The current studies indicate that music therapy may be able to improve mood and has low drop-out rates,” said lead author Anna Maratos, an arts therapist for the National Health Service in London. “While the evidence came from a few small studies, it suggests that this is an area that is well worth further investigation….We need to find out which forms have greatest effect.”

Ms. Maratos notes that music therapy might be particularly useful for adolescents who may reject a traditional form of counseling. Some older patients also may not be comfortable talking about their feelings, “but do tend to express themselves through song,” she said. Read more…

If you go to a mechanic, you tell the truth about what’s wrong with your car. When you go to the dentist, you’re clear about which tooth hurts.

But truth can be tougher with a therapist, notes psychologist John M. Grohol, in an essay on the PsychCentral Web site. Unlike aches and pains, the information you deliver to a therapist often involves your innermost thoughts and feelings or behavior you may not be proud of. Just as patients sometimes find it tough to disclose embarrassing personal health issues to a physician, patients also worry about confiding with their therapists, he notes.

“We’re embarrassed by what we need to say, and feel the doctor might pass some sort of judgment on us,” said Dr. Grohol. “Whether it’s a rational fear or not doesn’t really matter, does it? One of the reasons many people seek out psychotherapy in the first place is to help combat irrational thoughts and fears, so in that context, it makes sense many of us share this fear of being judged or embarrassed.”

If you do nothing else in therapy, says Dr. Grohol, learn to tell the truth.

“Your therapist won’t judge you, and they won’t be embarrassed by what you tell them,” he writes. “They won’t criticize you for not sharing this information with them sooner. All they will do is use it to find a way to better help you and help you move forward.”

For the full essay, click here.

No room for the car? Gaining control over your clutter could help you gain control of your health, too. (Credit: Joseph J. Delconzo for The New York Times)

Being disorganized is frustrating. But it can also stand in the way of better health.

That’s the focus of my Well column in Tuesday’s Science Times, which explains that many efforts to declutter focus on organizing the living space. But the real problem often isn’t the house, but the person. Sometimes disorganization is a symptom of a health problem, like attention deficit disorder, depression or a mental health issue called hoarding. And sometimes, the clutterer just needs to learn how to sort and prioritize and let things go.

Most experts agree that getting organized and cleaning up is good for your health.

“People don’t eat well because their kitchen isn’t functional, and they don’t sleep well because their beds are piled with stuff,” noted Lynne Johnson, a professional organizer from Quincy, Mass., who is president of the National Study Group on Chronic Disorganization. “I don’t see chronic disorganization ever becoming a medical diagnosis, but it is a contributing factor to noncompliance to taking meds and keeping appointments and being able to do exercise and eat well and all those things that so contribute to having a healthy life.”

Is clutter standing in the way of your health? Have you found a way to overcome chronic disorganization? Read the whole story here, and then post your comments below.

Treating some diabetic patients for depression may help prolong their lives, according to new research.

Investigators at the University of Pennsylvania divided 600 older patients with depression, including 123 who also had diabetes, into two groups. One group received care from primary care doctors, including drug therapy, counseling or both. The other group received a more focused treatment coordinated by a depression case manager.

Five years later, 110 patients had died. The leading cause was heart attack; only one patient had committed suicide. Notably, the researchers found that treatment of depression did not influence death rates among the otherwise healthy patients. But death rates among the diabetic patients were affected: the group who had received care from case managers were half as likely to die as those who had received less intensive care, the researchers discovered. The report appears in the current issue of Diabetes Care.

Although previous studies have demonstrated a link between depression and diabetes, this research is the first to show that aggressive treatment of depression can prolong the lives of diabetic patients. Read more…

Living in cube-isolation? (Romeo Gacad/AFP/Getty Images)

How friendly are you with your co-workers?

Although close relationships at work are often frowned on by bosses, it turns out that employees who are friendly with each other are better able to cope with office stress.

Researchers have long known that work stress can take a heavy toll on health. Studies have shown that stress at work increases the risk for depression, heart attack and other health worries. But now a new report shows that the solution to work stress may be found in the cubicle next door. Employees who feel social support at work are far less likely to suffer serious depression problems, according to a study published in the American Journal of Public Health. Read more…

“It’s probably just stress.” How many times have you uttered those words to yourself to dismiss a headache, pain or illness?

But stress is not “just” some benign complaint. Instead, it’s a powerful risk factor for disease, notes a recent commentary in The Journal of the American Medical Association. The article focuses on evidence showing that stress is linked to an increased risk for heart attacks, depression, cancer and the progression of H.I.V. and AIDS. Notably, an accompanying article in JAMA notes that workplace stress may be as bad for your heart as smoking and high cholesterol. And marital strife also poses a major risk to your heart health, the Archives of Internal Medicine reported this week. Read more…