OverviewStress, anxiety and depression and its impact on Heart DiseaseWritten with: Leo Pozuelo, MD Show
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 2 or more weeks, treatment is necessary to help you cope and recover. What is the role of depression in patients with cardiovascular disease?Up to 15 percent of patients with cardiovascular disease and up to 20 percent of patients who have undergone coronary artery bypass graft (CABG) surgery experience major depression.¹ Studies have shown that mental stress has a negative effect on a person’s heart health. In particular:
Symptoms and CausesHow 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. Talk to your health care provide who can diagnose and start depression treatment with safe antidepressants. Your health care provider also can refer you to a mental health specialist who can provide other appropriate treatment when necessary. When depression is negatively affecting your life — such as causing increased difficulties with relationships or performance at work or at home, it is important for you to get help to prevent things from getting worse. More specific reasons to seek help include:
Depressive disorders result from a mix of factors
Diagnosis and TestsHow 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: up to 10 percent 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:
Sometimes, symptoms of depression can be made worse 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 specific blood tests used to diagnose depression, there are various screening tools and diagnostic criteria used to make the proper diagnosis. The U.S. Preventive Services Task Force has recommended that clinicians ask two screening questions for depression, known as the Patient Health Questionnaire (PHQ-2), including:
If you answer yes to both of these questions, there is a high likelihood of clinical depression, and your health care provider can provide recommendations to help you get the treatment you need. Your health care provider can also administer the Patient Health Questionnaire 9 (PHQ-9), a nine-item question list that can better define your depression and guide treatment. Management and TreatmentHow 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 reuptake inhibitors) have an established safety record and are safe for cardiac patients. The antidepressants sertraline (Zoloft) and citalopram (Celexa) have been the best studied, are effective and safe in patients with heart disease, and also are available in generic forms. Psychotherapy can increase a person’s social support and help the patient develop more positive thinking patterns. Brief supportive models of talk therapy appear to be the most appropriate for helping the depression that cardiac patients experience. 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. In a recent intervention trial, physical exercise was found to have a significant effect on depression.⁸ Major intervention studies — both pharmacologic (SADHART, CREATE) and psycho-therapeutic (ENRICHD) — have been performed in patients who are clinically depressed after a heart attack. These studies are helping clinicians better understand the link and treatment of depression and heart disease and guide optimal treatments. Patients with a previous history of depression or who are experiencing severe depression can be the best responders to medication intervention.⁹⁻¹⁰⁻¹¹⁻¹²⁻¹³ Living WithTips for coping with depression
ConclusionEarly detection and treatment of depression in heart patients are crucial to improve a patient’s quality of life and possibly 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. 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. Tips for FamilyHere are some suggestions for living with a depressed person that may make things easier for you and more beneficial for the depressed person:
How does depression affect heart failure?Can depression cause heart disease or heart attack? When you experience depression, anxiety or stress your heart rate and blood pressure rise, there's reduced blood flow to the heart and your body produces higher levels of cortisol, a stress hormone. Over time, these effects can lead to heart disease.
What percentage of heart failure patients have depression?Depression in heart failure
Based on several studies, HF is associated with a higher risk of depression. Two large meta-analyses found that the estimated overall prevalence of depression in HF is approximately 20% to 30% (Table 1)19, 20.
What is the relationship between depression and cardiovascular disease?For years, scientists have known about the relationship between depression and heart disease. At least a quarter of cardiac patients suffer with depression, and adults with depression often develop heart disease.
Is depression common with heart failure?In patients with heart failure (HF), depression and anxiety disorders are common and associated with adverse outcomes such as reduced adherence to treatment, poor function, increased hospitalizations, and elevated mortality.
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