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Heart Failure - Stress & Depression

Manage Your Stress: Ten Ways to Ease Stress

By: Michael G. McKee, PhD, Section of Health Psychology, Department of Psychiatry and Psychology

  • Eat and drink sensibly. Alcohol and food abuse may seem to reduce stress, but it actually adds to it.
  • Assert yourself. You do not have to meet others' expectations or demands. It's okay to say "no". Remember, being assertive allows you to stand up for your rights and beliefs while respecting those of others.
  • Stop smoking or other bad habits. Aside from the obvious health risks of cigarettes, nicotine acts as a stimulant and brings on more stress symptoms. Give yourself the gift of dropping unhealthy habits.
  • Exercise regularly. Chose noncompetitive exercise and set reasonable goals. Aerobic exercise has been shown to release endorphins (natural substances that help you feel better and maintain a positive attitude).
  • Study and practice relaxation techniques. Relax every day—choose from a variety of different techniques. Combine opposites—setting aside a time for deep relaxation and a time for aerobic exercise is a sure way to protect your body from the effects of stress.
  • Take responsibility. Control what you can and leave behind what you cannot control.
  • Reduce stressors (causes of stress). Many people find that life is filled with too many demands and too little time. For the most part, these demands are ones we have chosen. Effective time-management skills involve asking for help when appropriate, setting priorities, pacing yourself and taking time out for yourself.
  • Examine your values and live by them. The more your actions reflect your beliefs, the better you will feel, no matter how busy your life is. Use your values when choosing your activities.
  • Set realistic goals and expectations. It's okay—and healthy—to realize you cannot be 100% successful at everything at once.
  • Sell yourself to yourself. When you are feeling overwhelmed, remind yourself of what you do well. Have a healthy sense of self-esteem.

There are several other methods you can use to relax or reduce stress, including:

  • Deep breathing exercises
  • Meditation
  • Progressive muscle relaxation
  • Mental imagery relaxation
  • Relaxation to music
  • Biofeedback (explained below)
  • Counseling, to help you recognize and release stress

Ask your healthcare provider for more information about these techniques.


Biofeedback helps a person learn stress-reduction skills by providing information about muscle tension, heart rate and other vital signs as a person attempts to relax. It is used to gain control over certain bodily functions that cause tension and physical pain.

What to do if you have trouble sleeping

You may experience insomnia (an inability to sleep) because of discomfort, stress from personal concerns or side effects from your medications.

If you cannot sleep, try these tips:

  • Establish a regular sleep schedule—go to bed and get up at the same time every day.
  • Make sure your bed and surroundings are comfortable. Arrange the pillows so you can maintain a comfortable position.
  • Keep your bedroom dark and quiet.
  • Use your bedroom for sleep only; don't work or watch TV in your bedroom.
  • Avoid napping too much during the day. At the same time, remember to balance activity with rest during recovery.
  • If you feel nervous or anxious, talk to your spouse, partner, or a trusted friend. Get your troubles off your mind.
  • Listen to relaxing music.
  • Do NOT take sleeping pills—they are very harmful when taken with your other medications.
  • Take any prescribed diuretics ("water pills") earlier, if possible, so you don't have to get up in the middle of the night to use the bathroom.
  • If you can't sleep, get up and do something relaxing until you feel tired. Don't stay in bed worrying about when you're going to fall asleep.
  • Avoid caffeine.
  • Maintain a regular exercise routine; do not exercise within 2 to 3 hours before bedtime.

It is normal for you to feel sad or depressed after a heart attack, cardiac surgery or procedure, recent hospitalization, a new diagnosis of heart disease or when heart failure symptoms prevent you from living life the way you would like. Depression 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 to be expected, but they should gradually go away within a few weeks as you get back to your regular 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 2 or more weeks, treatment is necessary to help you cope and recover.

What is the role of depression in patients with heart failure?

Studies show 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 failure, depression increases the risk for hospitalization; cardiovascular events, such as chest pains or a heart attack; and death.
  • During recovery from cardiac surgery, depression can intensify pain, cause worsened fatigue and sluggishness, or cause a person to isolate from family and friends. Patients who have had coronary artery bypass graft (CABG) surgery and have untreated depression after surgery also have an increased risk for hospitalization and death.

Depressive disorders result from a mix of factors, such as:

  • A person's family history, physical health, state of mind and environment.
  • Life transitions, losses and high levels of stress.
  • Imbalances in the chemicals that the body uses to control mood.
How do I know when to seek help?

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). You should seek help if:

  • Your negative feelings persist daily for 2 weeks or more.
  • You have much difficulty maintaining 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.
  • You have suicidal thoughts or feelings. 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.

Without treatment, depression can become worse. Your doctor or nurse can refer you to a mental health specialist who can provide the appropriate treatment when necessary.

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. Not getting treatment can be life-threatening. More than 10% of people battling depression commit suicide.

Your doctor or nurse can evaluate your condition by asking you to describe your symptoms. Since patients recovering from a medial illness, hospitalization or surgical procedure experience some common symptoms of depression including fatigue and insomnia, your doctor or nurse will pay attention to these additional symptoms of depression:

  • Withdrawal from activities
  • Lack of response to visits with family and friends
  • Increased negative thoughts
  • Tearfulness

Sometimes, symptoms of depression are caused by certain medications, a physical disorder, virus or illness. Your doctor or nurse may perform a physical exam or laboratory tests to determine if there is a physical cause for your depressive symptoms.

Your doctor or nurse will also evaluate your personal and family medical history, as well as any history of drug or alcohol use.

Although there are no tests 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. A healthy lifestyle including regular exercise, adequate amounts of sleep, a well-balanced diet, as well as relaxation and stress management techniques, can help you manage your 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 reuptake inhibitors) have an established safety record and are safe for patients with heart failure. Psychotherapy can increase a person's social support and help the patient develop more positive thinking patterns.

Tips for coping with depression

The following are some tips to keep in mind if depression has become a problem for you:

  • Get dressed every day.
  • Practice stress management and relaxation techniques.
  • Get out and walk daily.
  • Follow your prescribed exercise regimen.
  • Resume hobbies and social activities you enjoy.
  • Share your feelings with your spouse, friend, or a member of the clergy.
  • Get a good night's sleep.
  • Eat well-balanced, nutritious meals and follow prescribed dietary guidelines.
  • Ask your doctor or nurse 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.

The early detection and treatment of depression in heart patients are crucial to improve a patients quality of life and prevent a recurrent coronary event. When left untreated, depression can worsen heart failure and increase the risk of a heart attack. Safe treatments are available to help you cope with depression and help you manage your heart failure.

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