Dr. Jessica M. Ruff, MD, MPH

• Angina, which is chest pain that occurs when the heart does not receive enough blood flow.
• Heart attack, which happens if the arteries leading to the heart are completely blocked.
• Arrhythmia, or irregular heartbeat, which can develop if the heart does not have enough blood supply.
• Heart failure, which may occur if a heart attack damages the heart and it becomes too weak to pump enough blood to the rest of the body.

Certain factors may increase risk for the disease, like smoking, lack of exercise, being overweight, high cholesterol, high blood pressure, and diabetes. CAD tends to develop over decades, so it can go undetected until it has become quite severe. A diagnosis may be established using such tests as:

• Electrocardiogram (ECG), which records the heart's electrical activity over a period of time. ECGs can detect whether there is enough blood flow to the heart or if a heart attack has occurred.
• Echocardiogram (echo), which creates images of the heart using sound waves. Echos can show whether the heart is able to pump blood normally.
• Stress tests, where an ECG or echo is combined with exercise, like riding a stationary bike or walking on a treadmill. This test is done to find out if the heart can function properly while performing a strenuous activity.

Treatments for the disease include medications such as vasodilators, like nitroglycerin, which dilates (widens) the coronary arteries. CAD may also be treated by a procedure called angioplasty with stent placement, where a balloon is inflated inside a diseased artery to flatten the plaque deposits against the artery walls, creating more room for blood to flow.

In some severe cases of the disease, multiple arteries may be blocked, and an open heart surgery called coronary artery bypass surgery may be necessary. This operation transplants a vessel from another part of the body to form a graft that goes past the narrowed arteries, thus enabling blood to flow around those arteries.

We don't yet know what causes depression, but it's thought that it is a combination of genetic, biological, environmental, and social influences. Because of this, the most effective treatments for depression combine medication with psychotherapy. Therapy, especially cognitive-behavioral therapy, can be extremely helpful in resolving the negative thoughts and feelings that come with depression. It gives patients new tools that they can use themselves to cope when their depression is making them feel down.

Some of the common medications used to treat depression include antidepressants such as SSRI's (Prozac, Paxil, Zoloft) or atypical antidepressants (Cymbalta, Wellbutrin). It's important to remember that these medications have different effects on everybody, and no one medication works right for everyone. Patients may have to try a couple before finding the one that works just right for them. If the first medication they try doesn't work, they should talk to their doctor about trying something else. In extreme cases where medication is not enough, electro-convulsive therapy and hospitalization may be the answer to keeping a severely depressed person safe.

Depression is a difficult illness to deal with, but it is more common than believed and there are many people who can help. With the right treatment, individuals with depression can get back to fully enjoying life again.