The Mental Health and Heart Disease Connection

Imagine that you’ve just had a heart attack or another type of cardiac event. You’re in recovery, you’re shaken up, and you feel like your whole world has changed in an instant. You feel differently about yourself, your loved ones, about life in general. In other words, heart disease has rocked your world.

Understandably, your mood is probably a bit depressed. Facing your own mortality will do that. But you can’t really be clinically depressed, right? Fast forward to two weeks later — you’re feeling the same. Your family is telling you that it’s normal to be depressed after an illness or heart attack. Your doctor is saying that it could be a side effect of the medications you’re taking. All you know is that you can’t seem to shake it.  Could it be depression?

“Immediately after a heart attack, it can be difficult to determine what’s happening — whether [a depressed mood] is part of the normal healing process, or if it’s truly depression,” says Sharonne N. Hayes, M.D., Director of the Women’s Heart Clinic at Mayo Clinic in Rochester, MN. “A total of five symptoms have to be present for two weeks to make a diagnosis.” These symptoms include:

• Depressed mood
• Inability to enjoy usual activities
• Sleeping too little or too much
• Appetite changes – eating too little or too much, including changes in weight
• Behavior changes– either agitated or sluggish
• Decreased energy (fatigue)
• Sense of worthlessness or guilt
• Difficulty with concentration, indecisive
• Thoughts of suicide or death

Women, depression, and heart disease

Overall, it’s estimated that 18 percent of American women have depression, and women are twice as likely to have depression than men are.

When looking at people with heart disease, it’s estimated that 20 to 25 percent of all patients in a cardiac care unit are depressed at any given time — and if you also included those with symptoms of mild depression, that number goes up to around 50 percent. “Women are doubly disadvantaged,” says Hayes, “because we’re more likely to have depression, and we’re also more likely to die of heart disease” when compared to men.

But why does it matter if you have heart disease and depression? “If you’re depressed, it’s much harder to make the changes you need to make to get healthier,” says Hayes. Researchers believe this may be the reason that depression increases the risk of heart disease. “Depression doubles the risk of having heart disease, and it also doubles your risk of having a negative health outcome,” says Kathy Kastan, L.C.S.W., M.A.Ed, author of From the Heart: A Woman's Guide to Living Well with Heart Disease, and president of WomenHeart's Board of Directors from 2003-2007.

The increased cardiac risk may stem from personality traits, like chronic anger or chronic anxiety, which can lead to depression. “The most toxic personality traits are anger, antagonism, picking fights, looking at things negatively, and anxiety,” says Hayes. “Those behaviors are not good for your heart.”

“We all have stress in our lives — bad and good,” says Kastan. “It’s how we deal with it that makes a difference. How do we manage our lives so that we’re more effective, and more tolerant to what’s going on?”

Depression and heart disease: Action steps

Hayes says that a history of depression should be considered another possible heart disease risk factor, along with high cholesterol or high blood pressure. So what can you do to reduce your risk?

• Go to cardiac rehabilitation. “This is so important, because you’re accountable to someone,” says Hayes. If your doctor recommends it, go. If you’re not referred, ask.
• Manage stress. Employ relaxation techniques such as deep breathing, yoga, acupuncture, and meditation. “If you’re clenching your teeth and fists when you’re stressed, you have to teach your body to have the opposite response,” says Kastan. “One thing you can do immediately is to breathe. Learn to breathe from your diaphragm, and do it ten times in a stressful situation.”

• Exercise.  Exercising is the one thing you can be certain will lift your mood. “For people who are depressed, starting an exercise program works as well as Prozac in terms of response rates,” says Hayes.
• Connect with spirituality.  “I’m not necessarily talking about a religious spirituality,” says Kastan. “Just appreciate your place in the universe and where you fit. Put yourself or your circumstances into perspective.”
• Manage your anger.  Recognize what arouses your anger and avoid triggers. Look to role models to change your behavior.
• Take care of yourself.  Drink water, eat healthy, get enough sleep, exercise, pamper yourself somehow, and enjoy the simple pleasures in your life.
• Seek help.  “Most of us want a quick fix,” says Kastan. “We don’t want to take the time to deal with our depression — but many times, we need that extra set of ears to listen, and that extra set of hands to guide us where we need to go.”
• Counseling.  Psychotherapy can be highly effective in helping you change behavior and get on track to contentedness.
• Anti-depressants.   “Not everyone needs drugs, says Hayes. “But if your doctor is recommending it and you’re resisting due to the stigma of being on medication, I would encourage you to seriously consider it. Anti-depressants can be a short-term solution, and even a six-month course can get you back to feeling even-keel. SSRIs, the most commonly prescribed anti-depressants, have been shown to have some anti-platelet activity — a good side effect for women with heart disease.

Breaking the stigma

“There’s still a huge stigma attached to mental health issues and having heart disease,” says Kastan. The goal of WomenHeart in this area is both to educate women on mental health and heart disease, and also to raise recognition of depression within the medical community. Cardiologists need to recognize the cardiac risk of poor mental health, says Hayes. “And even if it does nothing but treat depression, we need to treat the depression. It is a medical illness that needs to be treated,” Hayes says.

“We certainly can’t be joyful all the time,” says Hayes. “But our goal is a happy heart — a content heart.”