Blue moods may predict an impending attack

People who are depressed have double the risk of death from a stroke as their happy-go-lucky counterparts.

The reason for this isn't clear, but research suggests that, at least in some cases, depression simply may be a symptom of an impending stroke. Or, it may indicate a so-called "silent stroke," which is not thought to have obvious symptoms.

"That is a real possibility because silent strokes, by definition, are not detectable clinically but might well produce depression and predict fatal stroke later," Brooks Gump, an associate professor of psychology at the State University of New York at Oswego , told HealthDay . Gump authored a study on the subject that was first published online last year in the journal Stroke .

Depression can have a number of causes, including heredity, changes in brain chemistry, coping with painful or difficult life events, certain medications and disorders such as Parkinson's and hormonal problems, according to the National Women's Health Information Center.

Symptoms, the center indicated, include feeling sad or anxious, lethargy, restlessness, irritability, loss of pleasure in activities once enjoyed, crying, feelings of hopelessness, changes in appetite, sleeping problems and difficulty concentrating.

Gump's study followed 13,000 men for 20 years. The average age of men at the start of the study was 46.

The researchers found that men who had the most symptoms of depression were twice as likely to die from a stroke as those with the least number of symptoms.

The rate of heart disease for men with depression was also higher. One in five men scored highest on a depression scale, and those men were 21 percent more likely to die of heart disease and had a 15 percent increased risk of dying of any cause than men who scored lowest on the depression scale.

Men with the highest depression scores were 103 percent more likely to die of a stroke than were those who scored lowest on the scale. The risk of death from stroke declined as the number of depressive symptoms went down. Men who were only slightly depressed had a 20 percent increased risk of stroke death, according to the study.

Even at the beginning of the study, all of the men who were participating were considered to have a higher than average risk of dying from a stroke or heart attack because they had other risk factors, such as high blood pressure, said Karen Matthews, a professor of psychiatry, psychology and epidemiology at the University of Pittsburgh, and one of Gump's co-authors.

But, Matthews told HealthDay , the researchers controlled for those factors.

The researchers could not conclude that mini-strokes were the cause of the increased risk of dying from stroke, however. "For that we would need a clinical trial with periodic brain scans," Matthews said.

But the bottom line, according to Matthews, is clear: "Clinicians should ask their patients about depression. When people feel depressed they should be considered for treatment - pharmaceutical or behavioral."