It is common to feel sad or depressed after a heart attack, cardiac surgery or procedure, recent hospitalization, or finding out you have heart disease. You may “have the blues” because you don’t know what to expect or because you can’t do simple tasks without becoming tired.
Feeling sad is normal, and you should gradually feel better in a few weeks as you get back to your normal routine. But sometimes, depression can last and interfere with your life. Clinical depression is serious, but very treatable. It is important to talk to your healthcare provider if you have symptoms of depression that don’t go away.
Is there a link between depression and heart disease?
Research shows that up to 15 percent of patients with cardiovascular disease and up to 20 percent of patients who have coronary artery bypass graft (CABG) surgery suffer from major depression.
Mental stress can have a negative effect on your heart health. In particular:
- Unmanaged stress can lead to high blood pressure, damage to your arteries, abnormal heart rhythms and a weakened immune system.
- Depression can cause changes in your cardiovascular system and blood that increase your risk of heart disease.
- Depression can increase your risk of having a heart attack and coronary artery disease. If you have heart disease, depression also increases your risk of having blood clots.
- In a landmark study, long-term depression increased the risk of dying to 17% within 6 months after a heart attack. Patients who did not have depression had a 3% risk of dying.
- Depression after cardiac surgery can cause pain and fatigue to be worse and cause you to avoid social situations. Untreated depression after CABG surgery also increases your risk of dying.
- Patients with heart failure and depression are at greater risk of being readmitted to the hospital and have a greater risk of dying.
- It is possible that there is a genetic link between the risk of depression and the risk of cardiac events after a heart attack.
- Having heart disease and depression can affect your quality of life.
- Depression can lead to poor lifestyle choices, such as smoking, drinking too much alcohol, lack of exercise, and poor diet, which can all affect your treatment and put you at risk for heart disease.
- The American Heart Association recommends that all cardiac patients take a survey to be screened for depression because of the strong connection between heart disease and depression.
How do I know if I need help for depression?
If you are recovering from heart surgery, a heart attack or have another heart condition, it is normal to feel sad and depressed for a few weeks.
It is important to call your healthcare provider if:
- You feel sad, depressed or negative every day for 2 weeks or longer.
- You have a lot of trouble taking part in your recovery or treatment plan. A lack of motivation or confidence can be a sign of depression.
- You have a lot of trouble getting through your daily routine, social activities and/or work.
- You don't have anyone to talk to about your feelings. Without someone 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 have thoughts of suicide, call your doctor or 24/7 Suicide Prevention Lifeline right away, or go to the nearest emergency room for help.
Your healthcare provider will help you get the right diagnosis and treatment.
National Suicide Prevention Lifeline
1.800.273.8255
Other Resources
Cleveland Clinic Center for Behavioral Health
216.636.5860 or 866.588.2264
National Alliance on Mental Illness
National Institute of Mental Health
How is depression diagnosed?
The biggest hurdle to helping people with depression is recognizing that they are suffering from it. About half of people with depression do not get the right diagnosis or treatment.
Depressive disorders are caused by a mix of factors that relate to:
- Your family history, physical health, state of mind and environment.
- High levels of stress, life transitions, loss and many other factors.
- Imbalances in the chemicals the body uses to control mood.
In order to make the right diagnosis, your healthcare provider will talk to you about your symptoms. Some symptoms of depression, such as trouble sleeping and fatigue are normal challenges for patients recovering from a medical illness, hospitalization or surgery. Your healthcare provider will assess these symptoms as well as other problems and feelings you describe.
Your healthcare provider will also talk to you about your personal and family medical history and any history of drug or alcohol use.
You may have a physical exam and/or lab tests to rule out other reasons for your symptoms, such as medications or another health issue.
There is not a blood test that can be used to diagnose depression, but screening tools and other criteria are used to make the right diagnosis.
The Patient Health Questionnaire (PHQ-2) includes 2 questions:
Over the past 2 weeks, have you felt down, depressed, or hopeless?
Over the past 2 weeks, have you felt little interest or pleasure in doing things?
If you answer yes to both of these questions, it is very likely that you are clinically depressed.
The Patient Health Questionnaire 9 (PHQ-9) is a nine-question that is also used to make a diagnosis and guide treatment.
What treatments are available for patients with depression?
There are many effective treatments for patients with depression. These include a variety of antidepressant medications and talk therapy (cognitive behavioral therapy). Your doctor may recommend one or both as part of your treatment.
There is nothing to be ashamed or embarrassed about if your doctor recommends therapy. It is a very helpful and positive way for you to get support and feel better.
If you need medication, your doctor will talk to you about the best choice for you.
A healthy lifestyle that includes regular exercise, getting enough sleep and a well-balanced diet, as well as relaxation and stress management techniques, can also help you manage depression. Research shows that physical exercise has a significant effect on depression.
The support of family and friends is very important if you are depressed. Understanding and dealing with depression can be difficult and stressful for you and those you live with. Please see the tips below and on the next page for ways to help everyone cope.
Tips to help you cope with depression
- Get dressed every day.
- Use stress management and relaxation techniques. Ask your healthcare provider for more information.
- Take a walk every day, even if it is just for a few minutes.
- Ask your doctor about joining a cardiac rehabilitation program or other exercise program and follow the plan.
- Take part in hobbies and social activities you enjoy.
- Share your feelings with family, friends or others you trust.
- If you are recovering from surgery or a hospital stay, limit visits with friends to 15 minutes at first. Visits can be longer as you feel better.
- Make sleep a priority. Try not to nap too much during the day so you can sleep longer at night. Set a bedtime and limit the time you spend with electronics before you go to sleep.
- Eat a well-balanced, heart-healthy diet, such as a Mediterranean diet or other plan your doctor or dietitian recommends.
- Ask your healthcare provider about support groups for you and your family to help you cope.
- Don’t turn to smoking, drugs, alcohol or overeating to cope. These increase your risk of heart disease. Talk to your healthcare provider if you have trouble avoiding these habits.
Tips for family members
- Encourage the depressed person to get professional help. Make sure an assessment is done by a trained mental health expert so the right diagnosis is made and treatment can be started right away.
- Learn about depression so you can understand what your family member is experiencing. There are many organizations and support groups that can help you learn more.
- Understand that depression is a disorder that affects the body, mind and relationships. Depression is not a personal weakness or failure.
- Help your family member follow his or her treatment plan and practice the coping techniques and problem-solving skills he or she learns in therapy. You may find it helpful to go to therapy sessions with your family member. Make sure he or she has and takes any prescribed medications, makes all recommended lifestyle changes and goes to all follow-up appointments.
- Understand 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. Consistent support and understanding are critical to recovery.
- Interact in a way that puts the depressed person in charge. For example, instead of suggesting, “Let’s go to the movies tonight,” try saying, “I’d like to see a movie tonight. Which one of these do you want to see with me?”
- Remember that treatment works but takes time. Your loved one will start to improve in 2 to 3 weeks, and be back to normal in a couple of months. Let him or her know that you notice improvements and let the person know they are doing a good job.
- Reward your family member with opportunities, such as visiting friends or going out to do things they enjoy, but don’t force him or her to do these things.
- Take time to be away from your loved one from time to time. It will help both of you.
- Consider family or marriage counseling. These types of therapy can help you and your loved one learn effective ways to cope
- Consider support from community support groups, either for the depressed person and/or yourself.
References
Frasure-Smith N, et al. Depression following myocardial infarction: Impact on 6-month survival. JAMA, October 20, 1993. 270(15):1819-1825.
Nakatani D, et al. Influence of serotonin transporter gene polymorphism on depressive symptoms and new cardiac events after acute myocardial infarction. American Heart Journal, October 2005. 150(4):652-658.
Ruo B, et al. Depressive symptoms and health-related quality of life: the Heart and Soul Study. JAMA, July 9, 2003. 290(2):215-221.
Gehi AK, et al. Self-reported medication adherence and cardiovascular events in patients with stable coronary heart disease: the Heart and Soul Study. Archives of Internal Medicine, November 2005. 165(2):2508-2513.
Gehi AK, et al. Relation of self-reported angina pectoris to inducible myocardial ischemia in patients with known coronary artery disease: the Heart and Soul Study. The American Journal of Cardiology, September 15, 2003. 92(6):705-707.
Litchman JH, et al. Depression and coronary heart disease: Recommendations for screening, referral and treatment. A science advisory from the American Heart Association Prevention Committee of the Council on Cardiovascular Nursing, Council on Clinical Cardiology, Council on Epidemiology and Prevention, and Interdisciplinary Council on Quality of Care and Outcomes Research: endorsed by the American Psychiatric Association. Circulation, Oct 21 2008. 118(17):1768-1775.
Blumenthal JA, et al. Exercise and pharmacotherapy in the treatment of major depressive disorder. Psychosomatic Medicine 2007. 69(7):587-596.
