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Jan 30, 2017

Understanding Depression and Heart Disease

Depression may be as big a risk factor as smoking, high cholesterol and high blood pressure, research suggests.

It’s normal to feel sad from time to time. Life isn’t always simple or easy to predict. And when faced with life-changing events, such as an illness, a death in the family, loss of a job, a divorce or other unexpected situations, allowing yourself time to grieve or express your feelings can be healthy.

In the same way, if you or a loved one is diagnosed with heart disease or is recovering from a heart attack, stroke, heart surgery or a stay in the hospital, you may find yourself flooded with anxiety and sadness. You might also worry about your future health and how your life will change.

While it can take time to come to terms with a diagnosis, if such feelings linger beyond a couple of weeks or months, pay attention. You (or your loved one) may have depression.

Long-term feelings of sadness or loss of interest in activities that usually make you happy can be telltale signs of depression.
More: Are you feeling depressed?

It’s important to speak up and get help. Treating depression can improve the health of your mind and body. And given that research continues to link depression and heart troubles, it may prove to be good for your heart, too.

How Depression Factors into Heart Health

Depression and heart disease are two common health conditions affecting adults in the U.S., and it appears they are closely related. In many cases, they go hand-in-hand. It can be difficult to know which came first.

For example, research suggests that depression or stress may be as big a risk factor for cardiovascular disease as smoking, high cholesterol and high blood pressure. People who are depressed also tend to develop heart disease at higher rates than those who aren’t depressed. Depression can also increase the chances of someone having a heart attack or stroke.

At the same time, people with heart disease or who are recovering from a heart attack or cardiac procedures are at greater risk of becoming depressed. For people with heart disease, depression is harmful not only because of the distress it causes, but research finds being depressed also puts them at risk of future heart problems, including another heart attack or dying. It can also delay recovery from heart surgery.

When compared to those without depression, people with heart disease and depression tend to have more health complications—even a higher chance of dying. Many health professionals now believe that people with acute coronary syndrome or those recovering from a heart attack, stroke or heart surgery should routinely be screened for depression.

The good news is that easing symptoms of depression seems to reduce a patient’s chance of having a heart attack, stroke or developing heart failure. In some cases, it reduced the risk to the same level as what would be expected among those who were not depressed, a recent study found. And depression is treatable.
    
Download Tips for Managing Depression

Did You Know?

  • About 1 in 5 people with heart disease report major depression.
  • Depression is up to three times more common among people recovering from a heart attack than the general population; survivors with depression have a three-fold risk of dying even after accounting for age, smoking, the severity of the heart attack or how well the heart is pumping.
  • 40% of people undergoing cardiac surgery have some level of depression after the procedure.
  • People with heart failure are at least three times more likely to suffer depression than the general public.
  • Women with heart disease are more likely to develop depression.

Depression’s Role

What’s behind this link?  There’s no definitive answer. However, what is known is that depression can affect your ability to manage your heart condition. Research also suggests depression can promote inflammation and other changes in the body that can harm the cardiovascular system.

In addition, behaviors that are often linked to depression may partly explain its effect on heart disease or worsening health.

For example, people who are depressed are more apt to:
  • Skip exercise
  • Overeat, or turn to comfort or convenient foods
  • Be anxious, which can make abnormal heart rhythms and high blood pressure more likely
  • Try to relieve stress on their own by taking alcohol or smoking cigarettes
  • Fail to take their medicine as directed (when taken as directed, medicine can prevent health problems from getting worse and even save lives)
  • Develop diabetes and gain weight

Also, certain changes can occur in the body that may also play a role. For example, people with depression and heart disease are less likely to have their blood pressure under control. People who have clinical depression also tend to have more inflammation and release “fight or flight,” or stress, hormones. Among people with heart disease, this can speed up the narrowing of the arteries (atherosclerosis). There is also some evidence that people with depression may have sticky red blood cells that can clump together to form clots, which can make a heart attack more likely.

All of these factors can harm your heart health or delay recovery.

Treatment Options

There are effective treatments for depression, and you don’t have to go it alone.

“Many caregivers and patients simply do not recognize that depression after a heart attack is a real medical diagnosis. Some mistakenly feel it is a sign of weakness.”
Joshua Liberman, MD, FACC, of Columbia-St. Mary’s Hospitals in Milwaukee.  
For mild depression, getting regular exercise and renewing your interest in activities that you enjoy may be enough. So, as much as you might dread the thought of lacing up your sneakers, do it. Exercise can boost your mood and make you feel physically stronger, too. If you are recovering from a heart event or surgery, talk with your health care provider before you start exercising and ask about cardiac rehabilitation.

It’s also important to teach yourself about your condition and lean on trusted friends and family for support. Try not to withdraw or cut yourself off from others. Don’t forget that a good cry session or sharing your fears can do wonders.

Other therapies include:  

  • Counseling. Talking through your feelings with a psychologist or counselor can help shift your thought patterns, including your response to heart disease or other challenges, in a more positive direction. It can also help you find ways to cope that can boost your confidence to better manage your condition. It’s also a safe place to vent or celebrate successes.
  • Antidepressants. For people with moderate-to-severe depression, medicine may be needed. Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) are most often used to treat depression. Your provider or therapist can help you decide which medicine might work best for you. Keep in mind: It may take a couple of weeks to find the right dose. Be sure to ask whether any new medication will interact with others you take.
  • Cardiac rehabilitation. For eligible patients, cardiac rehab offers supervised exercise training and psychosocial support. Cardiac rehab can not only improve your heart health, but it also can help improve your mental well-being, too.
  • Support groups. Find out if your hospital or cardiology practice knows of local support groups. Talking with other people who have had a heart attack or cardiac procedure can help you feel less alone.

The above are often used in combination.

Who Is at Risk for Depression?

Some people appear to be more prone to depression than others, especially as it relates to dealing with a chronic condition. For example, people may be more likely to become depressed if they:

  • Lack self-efficacy or a sense of control; they feel as if they don’t have the know-how or skills to manage their condition well
  • Don’t have anyone to confide in or lack a supportive social network
  • Already feel overwhelmed with life’s demands
  • Haven’t built coping skills to get through hard times
  • Have a family history of depression

If any of these applies to you or a loved one, consider talking with your health care provider about how to ward off possible depression.

Talking With Your Care Team

Make sure to tell your health care provider if you think you might be depressed. It’s nothing to feel ashamed of or embarrassed about. You’re not alone—more than 15 million adults in the U.S. suffer from major depression. The danger is that if you don’t speak up or seek treatment, depression can take a toll on your life, including your heart health.

Here are some questions that may be helpful to ask:

  • I worry I might be depressed. What are the signs?
  • What can I do to ward off depression?
  • Is there a safe exercise program for me?
  • Do I need counseling?
  • Do you think I can try to manage my depression without taking medication?
  • Is there a therapist you would suggest?
  • If I need it, what type of antidepressant would you recommend for me?
  • How long will it take for medicine to work or to find the right dose?
  • Do these medications interfere with any others that I take?
  • Am I eligible for cardiac rehabilitation?
  • Are there any support groups available?
  • How can I explain my depression to my family members and what I need from them?
  • Is there anything else I can do to manage depression and my heart risks?

Helpful Resources

To learn more about your heart condition or risk, CardioSmart.org has a wealth of resources and tips. Visit our condition centers.

Other organizations that provide important information and tips about depression include:

The American Psychological Association
www.apa.org

Anxiety and Depression Association of America
www.adaa.org

National Alliance on Mental Illness
www.nami.org

There are support groups for women (live and virtual) at womenheart.org for women.

Published: January 2017
Medical Reviewers: Martha Gulati, MD, MS, FACC, FAHA, FASPC, Editor-in Chief of CardioSmart; Joshua Liberman, MD, FACC; Sabrina Stone, MD, FACC

Featured Video

Recognizing and treating depression is important because it can slow down a heart patient's recovery and increase the risk of future coronary disease.

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