Depression Raises Midlife Women's Stroke Risk

Women in their 40s and 50s have a very low risk of stroke, but the risk doubles if they are depressed, a new study finds. The study included 10,547 women who had no history of stroke. Their ages ranged between 47 and 52 when the study began. Researchers had them fill out health surveys every 3 years for the next 12 years. In that time, 177 women had strokes. The stroke rate among women with depression was 2.4 times as high as for women without depression. Depressed women also were more likely to have other health factors, such as smoking, that increased their risk of stroke. After researchers accounted for those factors, depression alone almost doubled the women's risk of stroke. Overall, about 1.5% of the women had strokes during the study. The journal Stroke published the study. HealthDay News wrote about it May 16.

By Howard LeWine, M.D.
Harvard Medical School

What Is the Doctor's Reaction?

Stroke is a major cause of long-term disability and death in the United States. Women have a higher lifetime risk of stroke than men. This is especially true for women in middle age. And the risk has been increasing.

Stroke rates in midlife women have risen during the last 25 years. Some estimates suggest they might have tripled. Stroke rates in men of similar age stayed flat over this same period.

Scientists don't know why stroke rates have increased for midlife women, and not for men. Depression seems to be a likely contributor. Prior studies have shown a definite link between depression and stroke in both sexes. But depression rates in women are twice as high as in men throughout the lifespan.

The results of this study add more evidence to the link between depression and stroke among women. The data came from the Australian Longitudinal Study on Women's Health. The researchers enrolled women ages 47 to 52 to look at their health during early midlife.

To identify depression, the researchers used a depression scale or recent use of an antidepressant drug. Of the 10,547 women, 24% were depressed. The stroke rate in the depressed women was 2.4 times as high as in non-depressed women.

Women with depression were more likely to have other factors that increased the risk of stroke. They included:

• Smoking
• High blood pressure
• Heart disease
• Diabetes
• Lack of exercise
• Overweight and obesity

When the researchers took out the impact of these risk factors, depressed women still had 1.9 times the stroke rate of non-depressed women.

Other studies have also found somewhat higher stroke rates for depressed women, primarily women in later stages of midlife. But depression made an even bigger difference in stroke rates for the younger midlife women in this new study.

This is not proof that depression causes stroke. But many experts do think there is a biological connection. We just haven't discovered it yet.

What Changes Can I Make Now?

Depression isn't the same in everyone. And feeling sad might not be the major symptom.

Here are some of the other symptoms:

• Feeling helpless or hopeless
• Loss of interest in activities you used to enjoy
• Trouble concentrating or remembering things
• Sleep changes (can't sleep or sleep too much)
• Anger or irritability
• Appetite or weight changes (can be either more or less)
• Reckless behavior, such as excessive alcohol use or reckless driving
• Feeling worthless

There may be reasons other than depression for these symptoms. But depression is one of the most common causes.

Obviously, you should seek treatment if you have depression. But also recognize the link between depression and other medical problems such as heart disease, diabetes and obesity. Taking positive action to improve your health can also lessen your symptoms of depression.

What Can I Expect Looking to the Future?

Depression not only increases stroke risk, it also means you are more likely to have a heart attack or develop other types of heart disease. We don't yet know if and what types of depression treatment will help lower these risks. This is an area of active research.

My prediction is that scientists will discover a biological or genetic reason that puts a person at risk for all three -- depression, heart disease and stroke.