Researchers followed 1,243 patients who sought treatment for new or worsening PAD symptoms at a vascular specialty clinic for one year. At the start of the study, and again at 6 and 12 months, they asked patients how often they had symptoms of depression like fatigue, trouble sleeping, little interest or pleasure in doing things, poor appetite or overeating, or feeling hopeless or bad about themselves. “Amongst those who had significant depressive symptoms when they consulted their vascular specialist for new PAD symptoms, health status and quality of life outcomes were majorly lagging behind throughout their one-year follow-up, despite being offered similar treatments as their nondepressed counterparts,” says senior study author Kim Smolderen, PhD, a clinical health psychologist and co-director of the Vascular Medicine Outcomes (VAMOS) program at Yale School of Medicine in New Haven, Connecticut. “The differences were large and clinically meaningful,” Dr. Smolderen adds. PAD develops when narrowed arteries lead to reduced blood flow to the limbs, primarily the legs. Insufficient blood flow can make it painful and difficult to walk and complete other daily tasks, and significantly reduce quality of life. People with PAD also have an increased risk of coronary artery disease, heart attacks, and strokes.
Limitations of the Study
One limitation of the study is that researchers relied on patients to report any symptoms of depression, not on depression diagnosed by a clinician or documented in medical records. Another drawback is that because all of the patients were seen at specialty clinics, it’s possible the results might not be generalizable to people treated in primary care or other settings. It’s also not clear from the study whether people developed depression symptoms after they got diagnosed with PAD, or if they might have had preexisting mental health conditions. “We do not know what comes first, and most likely, we are dealing with a multidirectional relationship,” Smolderen says. “There is evidence that depression is linked with an increased incidence of cardiovascular diseases, and that patients with established cardiovascular disease have a higher risk of developing depression.” RELATED: Mental Illness, Signs, Symptoms, Treatment, and More
Disparities Seen in Earlier Studies
Other studies have documented worse PAD outcomes for women and for men. One study in the Journal of the American Geriatrics Society, for example, found that women with PAD are more likely than men to have extreme leg pain both at rest and with exertion, and also have greater walking impairment from leg symptoms. Another study in the Journal of the American Board of Family Medicine found that even though the prevalence of PAD is similar for women and men, women with PAD had more pronounced physical limitations and were more likely to have symptoms that interfere with daily life. While previous studies haven’t examined the association between depression and PAD symptoms or how this may differ for men and women, the findings of the current analysis mirror what earlier research has found in people with coronary artery disease. One study in the Journal of the American Heart Association, for example, followed 2,411 heart attack patients for one year and found that women were more prone to depression than men. And, depression was associated with a 24 percent greater chance of dying during the study. RELATED: The Best Heart Health Tests for Women
Adjustment Disorder Common With New Diagnosis
“We’ve known for a long time that depressive symptoms in general are strongly associated with worse cardiovascular outcomes,” says Joseph Ladapo, MD, an associate professor at the David Geffen School of Medicine at the University of California in Los Angeles. It’s not uncommon for people newly diagnosed with a serious chronic health issue like PAD to experience what’s known as adjustment disorder, a cluster of symptoms that can include feeling stress or sadness or difficulty coping, Dr. Ladapo says. This can contribute to depressive symptoms and anxiety, and so can pain and disability caused by PAD. Depressive symptoms may also prevent people with PAD from getting ideal outcomes from treatment, Smolderen says. People with poor mental health might not follow treatment regimens consistently, or they might not perceive as much improvement.
Talk to Your Doctor About Your Mood
It’s crucial to talk to your doctor about symptoms that might not seem directly related to PAD, like difficulty sleeping or a sudden loss of interest in food, Smolderen advises. “Bringing concerns about your mood up to your provider is an important first step,” Smolderen says. “There is evidence-based care available to treat depression.” While it’s not clear that treating depression with medication will improve PAD outcomes, it can still help with the underlying mental health concerns, notes Ladapo. “And, other approaches to alleviating depressive symptoms, such as regular exercise, will also improve PAD outcomes,” Ladapo says.
