The Heart Attack-Depression Link
Learn how to recognize the signs and find help.
By Cynthia Ramnarace
Medically Reviewed by Rosalyn Carson-DeWitt, MD
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No one is ever truly prepared for a heart attack. So when one hits, your life can be turned upside down. There are new medications to take, diet and lifestyle changes to institute, and, sometimes, anxiety over your near-brush with death to manage.
All of these things can make you feel depressed. But no one — neither heart attack survivors nor their caregivers — should ignore the symptoms of this serious mental condition.
"When depression occurs after a heart attack, there is an increased risk of death," says cardiac psychologist Kim Lebowitz, PhD, director of the Cardiac Behavioral Medicine Service of the Bluhm Cardiovascular Institute of Northwestern Memorial Hospital in Chicago. "So not only does depression not feel good, and not only does it affect a person's quality of life, but it also seems to impact their prognosis and their longevity after a heart attack."
Depression is very common after a heart attack. According to the American Academy of Family Physicians, as many as one out of three heart attack survivors report feeling depressed in the days and months after their episode. Women, and particularly younger women, are at increased risk of depression, reports the American Heart Association (AHA), as are people with a history of depression and those who lack a family or social support system.
In fact, the AHA emphasized the importance of screening heart disease patients for depression in new guidelines for heart disease prevention and risk reduction developed along with the American College of Cardiology Foundation. The guidelines note that depression after a heart attack or heart surgery can interfere with patients' abilities to make positive lifestyle changes, like eating healthier, exercising more, quitting smoking, and losing weight.
Symptoms of Post-Heart Attack Depression
Depression is more than just a fleeting feeling of sadness, Dr. Lebowitz says. What doctors call clinical depression occurs when the following symptoms are present for at least two or more weeks:
- Feeling sad or crying often
- Losing interest in activities you used to enjoy
- Changes in appetite, weight, and sleep habits (either too much or not enough)
- Feeling agitated, cranky, or sluggish
- Feelings of guilt and worthlessness
- Trouble concentration and making decisions
- Thoughts of suicide or death
Understanding the Depression-Heart Attack Link
The exact relationship between depression and cardiovascular health is still a mystery. Is the depression a symptom of heart disease? Or does the depression negatively impact heart health? Researchers can't answer either question definitively. But what they do say is that while there's no direct evidence that identifying depression can reduce your risk of cardiac death, the data shows that depressed people are often sicker post-heart attack and have a greater risk of cardiac death than those who are not depressed. In addition, people who are depressed have higher levels of biomarkers, such as inflammation, that can increase their risk of a second cardiac event.
There is also a behavioral link between depression and heart attack. "We know that when individuals are depressed, they're less likely to stop smoking, less likely to comply with their medications and follow up with appointments, and less likely to exercise," Dr. Lebowitz says, "And they're more likely to drop out of cardiac rehab and to eat a diet rich in calories and fat and high cholesterol." For these reasons, he notes, seeking treatment for depression is crucial for their physical as well as their mental health.
How to Treat Depression after a Heart Attack
Antidepressants called selective serotonin reuptake inhibitors (SSRIs) have been successful in treating depression in heart attack survivors. The benefits seem to reach even beyond the depression itself: A trial involving heart attack survivors and two of the most common antidepressant medications, sertraline (Zoloft, Lustral, Aslopie) and citalopram (Celexa), showed a 42 percent reduction in risk of death or second heart attack compared to those not taking antidepressants. While these results are impressive, researchers say more study must be done before a definitive link can be claimed.
The same study showed that cognitive behavioral therapy, which focuses on replacing negative thoughts and behavior patterns with more positive ones, can help alleviate the depression, but works best when received in at least 12 weekly sessions. Exercise is also beneficial in reducing depressive symptoms, the American Heart Association reports.
Fortunately, 80 to 90 percent of those who seek treatment for depression find relief from their symptoms. And once the depression lifts, your quality of life will improve, and so will the odds that you will take a proactive approach to your health care needs — two factors that can help contribute to a healthier, and longer, life.
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