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The Relationship between Depression and Blood Pressure
Adrian Drew
When people consider common symptoms of depression, high blood pressure isn't one that typically springs to mind. Instead, most tend to think of emotional symptoms like feelings of hopelessness, debilitating sadness, and reduced self-esteem. The truth, however, is that depression and blood pressure elevation, also known as hypertension, can indeed be
connected.
Why is this? A lot of it has to do with a sometimes useful but often problematic hormone called cortisol—the stress hormone. Cortisol triggers processes in your body that help you respond to stress, such as increasing your heart rate or changing your level of alertness. The constant stress of depression, as well as any associated anxiety, can signal the body to produce more cortisol.
In small doses, cortisol can be beneficial. Normal levels are released when we wake up in the morning, for example, and seek to heighten our alertness in preparation for the day ahead. In excess, however, cortisol can give rise to a number of issues, such as weight gain or a weakening of the immune system.
So how exactly does cortisol work, and what does it have to do with depression and high blood pressure?
The Link between Cortisol, High Blood Pressure, and Depression
As noted above, it's cortisol that links depression with blood pressure, since
cortisol is typically released when our brains perceive danger. This natural evolutionary response prepares us to either fight a threat or run from it through a number of different mechanisms—a process typically referred to as the "fight-or-flight" response. Our heart, for example, is instructed to pump more blood to muscles essential to our survival in order for us to better tackle a perceived threat effectively. Cortisol and adrenaline are also released into the bloodstream, heightening our reflexes and preparing us for the coming challenge.
This fight or flight response had its uses back when physical danger was a part of our ancient ancestors' day-to-day lives. This mechanism would have enabled cave-dwelling early humans to outrun or confront perils like saber-toothed tigers and other animals looking to harm us. Now, however, it can be problematic, particularly where depression is concerned. Cortisol is released at times when our life isn't in physical danger, and it's often responsible for the feelings of anxiety and unease experienced by those with depression. The body perceives danger and reacts how it sees fit—by preparing us for a fight that doesn't come.
Since stress and anxiety are both common symptoms of depression (or in some cases, contributors to depression), an individual with depression may have higher levels of cortisol. Since cortisol is responsible for increasing blood pressure to prepare us to confront danger, a person with depression may develop higher blood pressure as a result.
A Treatable Condition
Thankfully, both depression and high blood pressure are treatable. While treating depression may not resolve high blood pressure, hypertension alone can sometimes be treated with a few
lifestyle modifications , such as increasing exercise, eating a healthy diet, and cutting back on alcohol. For many, though, the best way to treat hypertension is through medication. It's important to work with your doctor to understand the best way to treat your hypertension in order to minimize the
risk of damage to your heart, brain, kidneys, and other organs.
Depression is a medical condition that requires intervention and cannot be eliminated through lifestyle changes alone. Talk therapy and medication are two of the most common treatments for depression. Of course, since every individual is different, these treatments might not work as well for some as they do for others. In cases where talk therapy and antidepressants haven't been effective, transcranial magnetic stimulation (TMS) therapy is another option.
TMS therapy uses FDA-cleared devices that emit a gentle magnetic pulse to stimulates areas of the brain responsible for mood regulation. Over the course of six to nine weeks, TMS therapy can help to mitigate common symptoms of depression and work to boost an individual's mental well-being. To learn more about whether TMS therapy is right for you, schedule a no-cost consultation .
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Starting any medical treatment for the first time can leave you with questions, especially if you’re looking forward to the benefits it may bring. It’s no different when you’re preparing for your nasal esketamine treatment. Your previous mental health treatments may have consisted solely of taking antidepressants at home or visiting a therapist’s office for cognitive behavioral therapy (CBT), so nasal esketamine is probably a new treatment experience for you. If you're wondering what it's like to start nasal esketamine and get ready for your first session, keep reading. Getting Started with the Nasal Esketamine Treatment As with any new treatment, you’ll first talk to your primary care provider or psychiatrist about whether nasal esketamine is a good fit for you. Alternatively, you can schedule your esketamine nasal spray consultation with a treatment center (such as Greenbrook) that has certification by the FDA’s Risk Evaluation and Mitigation Strategy (REMS). At Greenbrook's REMS-certified nasal esketamine treatment centers, our Greenbrook-affiliated psychiatrists and psychiatric nurse practitioners will review your medical history and also conduct our own assessment to help determine whether nasal esketamine treatment is right for you. Certain conditions, including blood vessel disease and a history of psychosis, may make treatment a risk for you. Make sure you discuss all previous and present conditions with your doctor or nasal esketamine provider before beginning treatment. If the medication is deemed a good fit, you’ll receive your prescription from the Greenbrook-affiliated provider. Your Greenbrook Care Team will put together a personalized care plan for the weeks and months to follow. Keep in mind that you will need to take a standard (oral) antidepressant along with your nasal esketamine treatment. There are two important regulations to note when it comes to preparing for treatment: Each treatment is followed by a mandatory two-hour observation period. This means you will need to plan to stay at the center for at least two hours following your self-administration of the esketamine nasal spray. You cannot drive during the rest of the day after treatment and must arrange for transportation. These regulations are mandatory. It may be helpful to sit down and plan out several weeks’ worth of transportation once you know your treatment schedule. In addition, if you’re wondering what to bring for the treatment, we recommend entertainment such as an audiobook or playlist of favorite songs and a pair of headphones. You may want them during the two-hour observation period. What to Expect During Nasal Esketamine Treatment On the day of treatment, you’ll need to stop eating any food two hours before your appointment and stop drinking all fluids 30 minutes before you come in. Your Greenbrook Care Team will confirm that you are prepared for the two-hour observation period and that you have a ride home. You’ll get the opportunity to practice using a “trainer sprayer” that mimics the real nasal esketamine sprayer but does not release any medication. The Care Team will encourage you to use the restroom and set up your preferred environment in your private treatment bay or room. Some patients like reduced lighting, for example, while others don’t request light adjustments. You’ll complete a depression scale before each treatment session. Your Greenbrook provider will confirm that the dose kit is yours, show you how to administer it, and then hand it to you. Each sprayer contained 28mg of Spravato esketamine nasal spray. Patients usually start with two sprayers (56mg) and soon increase to 84mg (three sprayers) per treatment. But, your dosage maybe vary. Should you be left with a metallic taste by the spray, the Care Team will offer suckers to help make the flavor dissipate. After your dose, you’ll be encouraged to lie back in your comfortable recliner. While most patients enjoy a quiet setting, Greenbrook is prepared to accommodate patients with a more animated reaction to the medication. You may feel sleepy, dizzy, mildly dissociated, and/or nauseated during treatment. Greenbrook's Care Team is readily available if you need assistance. How to Prepare for after your Nasal Esketamine Treatment Most side effects begin to wane in the second hour of observation, but if you’re wondering, “Is it safe to drive immediately after nasal esketamine treatment?” the answer is a resounding no. In addition to the mandatory ride home, you will need to block off time to rest and let side effects fully dissipate. This extended rest period is especially important in the first weeks of treatment when you’ll have treatment twice a week. Do not drive or operate machinery of any kind until the day after treatment. Just take it easy, relax, and take care of yourself. If you’re unsure what activities you can do or should avoid during this time, talk to your Care Team for more information. While side effects tend to dissipate completely after a good night’s sleep, many nasal esketamine patients begin feeling relief from depression symptoms within hours of their treatment. Other Tips in Preparing for Your Nasal Esketamine Treatment At Greenbrook, we make every effort to schedule your treatment in the afternoons or whenever it is most convenient for you. We encourage you to see each treatment session as an opportunity to relax and take care of your mental health. If you have any questions or concerns, talk to your doctor or the Greenbrook Care Team. At Greenbrook, we’ll help you feel at ease when preparing for each treatment session. Schedule A Free Consultation To get started with nasal esketamine, schedule your free consultation today.
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