written with Leo Pozuelo, M.D., Department of Psychiatry and Psychology
It is common for you to feel sad or depressed after a heart attack, cardiac surgery or procedure, recent hospitalization, or new diagnosis of heart disease. These emotions may be the result of not knowing what to expect or not being able to do simple tasks without becoming overly tired.
Temporary feelings of sadness are normal, and should gradually go away within a few weeks, as you get back to your normal routine and activities.
Sometimes, however, a depressed mood can prevent you from leading a normal life. When a depressed mood is severe and accompanied by other symptoms that persist every day for two or more weeks, treatment is necessary to help you cope and recover.
What is the role of depression in cardiac patients?
Studies have shown that mental stress has a negative effect on a person’s heart health. In particular:
- Unmanaged stress can lead to high blood pressure, arterial damage, irregular heart rhythms, and a weakened immune system.
- For people with heart disease, depression increases the risk for an adverse cardiac event such as a heart attack or blood clots. For people who do not have heart disease, depression increases the risk of heart attack and coronary disease.
- One in six patients who have had a heart attack suffer from clinical depression. In one study, the continued presence of depression after recovery increased the risk of death (mortality rate) to 17% within six months after a heart attack (versus 3% mortality in heart attack patients who didn’t suffer from depression).
- During recovery from cardiac surgery, depression can intensify pain, cause worsened fatigue and sluggishness, or cause a person to withdraw into social isolation. Patients who have had coronary artery bypass graft (CABG) surgery and have untreated depression after surgery also have an increased morbidity and mortality rate.
- Patients with heart failure and depression have an increased risk of being readmitted to the hospital within three months to one year after their hospitalization.
- Negative lifestyle habits associated with depression - such as smoking, excessive alcohol consumption, lack of exercise, poor diet, and lack of social support – interfere with the treatment for heart disease.
Depressive disorders result from a mix of factors that relate to:
- A person’s family history, physical health, state of mind and environment
- High levels of stress, life transitions, loss and many other factors
- Imbalances in the chemicals that the body uses to control mood
How do I know when to seek help?
If you’re recovering from heart surgery, a heart attack, or another heart condition, temporary feelings of sadness and a depressed mood are common for the first few weeks.
However, treatment is necessary when depression is severe and accompanied by other symptoms (including withdrawal from activities, not responding when visiting with family and friends, increased negative thoughts, and tearfulness).
Without treatment, depression can become worse. For heart patients, depression can contribute to an increased risk of heart attack and coronary disease. Your health care provider can refer you to a mental health specialist who can provide the appropriate treatment when necessary.
When depression is negatively affecting your life — such as causing difficulties with relationships, work issues, or family disputes — and there isn’t a clear solution to these problems, then you should seek help to prevent things from getting worse.
More specific reasons to seek help include:
- You have suicidal thoughts or feelings. Suicide is an irreversible solution to problems and causes permanent harm to family members and friends. If you are having thoughts of suicide, call your physician or local 24-hour suicide hotline right away, or go to the nearest emergency room for help.
- Your negative feelings persist daily for two weeks or more.
- You have significant difficulty with your daily routine, social activities and/or work.
- You don’t have anyone in whom you can confide. If you don’t have anyone to share your thoughts with, it’s hard to know if what you’re thinking makes sense.
How is depression diagnosed?
The biggest hurdle to diagnosing and treating depression is recognizing that someone is suffering from it. Unfortunately, approximately half of the people who experience depression are never diagnosed or treated for their illness. And not getting treatment can be life-threatening: more than 10% of people battling depression commit suicide.
Your health care provider can evaluate your condition by asking you to describe your symptoms. Since patients recovering from a medical illness, hospitalization or surgical procedure experience some common symptoms of depression including fatigue and insomnia, your health care provider will pay attention to these additional symptoms of depression: withdrawal from activities, lack of reactivity from visits with family and friends, increased negative thoughts, and tearfulness.
Sometimes, symptoms of depression are caused by certain medications, a physical disorder, virus or illness. Your health care provider may perform a physical exam or laboratory tests to determine if there is a physical cause for your depressive symptoms.
Your health care provider will also evaluate your personal and family medical history, as well as any history of drug or alcohol use.
Although there are no tests used to diagnose depression, there are various screening tools and diagnostic criteria, developed by the American Psychiatric Association, used to make the proper diagnosis.
How is depression treated?
There are many treatments for depression. Major depressive disorder may be treated with antidepressants, psychotherapy
(supportive counseling or “talk therapy”), or a combination of both. Newer, safer antidepressant medications, such as SSRIs (selective serotonin re-uptake inhibitors) have an established safety record and are safe for cardiac patients. Psychotherapy can increase a person’s social support and help the patient develop more positive thinking patterns.
A healthy lifestyle including regular exercise, proper sleep, a well-balanced diet, as well as relaxation and stress management techniques can help you manage depression.
Major intervention studies — both pharmacologic (SADHART) and psychotherapeutic (ENRICHD) — have been performed in patients who are clinically depressed after a heart attack. These studies will hopefully lead to further intervention studies.
Tips for Coping with Depression
- Get dressed every day.
- Practice stress management and relaxation techniques.
- Get out and walk daily.
- Follow your prescribed exercise regimen. Ask your health care provider about a cardiac rehabilitation program.
- Resume hobbies and social activities you enjoy.
- Share your feelings with your spouse, friend or a member of the clergy. During your recovery from surgery or a recent hospitalization, visits with friends should be limited to 15 minutes at first. Then, increase the amount of time spent with visitors, depending on how you feel.
- Get a good night’s sleep.
- Eat well-balanced, nutritious meals and follow your prescribed dietary guidelines.
- Ask your health care provider about support groups that may help you cope. Support groups are available for patients who have had heart surgery and their families.
- Don’t use harmful habits to cope, such as smoking, overeating, using drugs or drinking excessively. These harmful habits increase your risk for heart disease and stroke.
Conclusion
The early detection and treatment of depression in heart patients are crucial to improve a patient’s quality of life and prevent a recurrent coronary event. When left untreated, depression can worsen heart disease and increase the risk of a heart attack. Safe treatments are available to help you cope with depression and help you manage your heart disease.
Tips for family
The support and involvement of family and friends can be crucial in helping someone who is depressed. Living with a depressed person can be very difficult and stressful on family members and friends. Here are some suggestions for living with a depressed person that may make things easier for you and more beneficial for the depressed person:
- Encourage the depressed person to seek professional help. Make sure an assessment is done by a trained mental health professional so the proper diagnosis and treatment can be initiated without delay.
- Educate yourself and your family about depression so you can understand what your family member is experiencing. There are many organizations and support groups that can provide more information.
- Know that depression is a disorder with biological, psychological, and interpersonal components; it is not a personal weakness or failure.
- Help your family member follow the prescribed treatment plan and practice the coping techniques and problem-solving skills he or she is learning during psychotherapy. Make sure medications are available if prescribed, attend therapy sessions with your family member if needed, recommended lifestyle changes and encourage him or her to follow up with the proper health care providers.
- Recognize that depression is often expressed as hostility, rejection, and irritability.
- Offer consistent support to your loved one. This can be draining, but it is one of the most important parts of a treatment plan. People with depression can feel alone and isolated. Giving consistent support and understanding are critical.
- Adopt an interaction style that puts the depressed person in charge. For example, instead of suggesting, “Let’s go to the movies tonight,” try this: “I’d like to see a movie tonight. Which one of these do you want to see with me?”
- Remember that treatment is effective and your loved one will start to improve in two to three weeks, achieving full improvement in a couple of months. Notice and praise any significant improvement.
- Reward your family member with opportunities such as visiting friends or going out for activities. Don’t force these, though.
- Take breaks from the depressed person from time to time. It will help both of you.
- Consider family or marital therapy: these forms of therapy bring together all those affected by depression and help them learn effective ways to cope together.
- Consider turning to support groups, either for the depressed person, or for you as his/her family member.
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