Heart disease and depression
You feel a tight band of pain around your chest. The pain moves from your chest to your arms, shoulder, and neck. What could your pain mean? Could it be a heart attack, could it be the big one? Heart attacks are caused by interruption of blood supply to part of the heart. If the blood flow is blocked, your heart is starved of oxygen and heart cells die. A hard substance called plaque can build up in the walls of your coronary arteries. This plaque is made up of cholesterol and other cells. A heart attack can occur as a result of plaque buildup or the rupture of one of these plaques. We're not sure why heart attacks occur when they do. You may have a heart attack when you are resting or asleep, or after a sudden increase in physical activity, when you are outside in cold weather, or after a sudden, severe emotional or physical stress, including an illness. So, how is a heart attack treated? If you go to the hospital for a suspected heart attack, a doctor or nurse will listen to your chest with a stethoscope. You will have a blood test to look for heart damage. A coronary angiography test can show your doctor how well blood is moving through your heart. If blood moves slowly, or not at all through your coronary arteries, you have either a narrowed, or blocked artery. Other tests can look at the valves and chambers of your heart and check for abnormal heart rhythms. If you've had a heart attack, doctors can do an emergency procedure called angioplasty. This surgery or procedure can open narrowed or blocked blood vessels. Usually they'll place a small, metal mesh tube, called a stent, in your artery to help keep it open. You may also receive drugs to break up the clot in your artery. Sometimes, doctors will do heart bypass surgery to get blood flowing to your heart muscle again. After you are treated in the hospital for a heart attack, you may need to take medicines to thin your blood, to protect your heart, or to improve your cholesterol levels. You may need to take these medicines for the rest of your life. Most people who have had a heart attack also need cardiac rehabilitation. This will help you slowly increase your exercise level and learn how to follow a healthy lifestyle. After you have a heart attack, your chance of another is higher. How well you do after a heart attack depends on the damage to your heart and where the damage is, and what steps you take to prevent another one. If your heart can no longer pump blood to your body as well as it used to, you may have heart failure and will need lifelong treatment. Usually a person who has had a heart attack can slowly go back to normal activities, but you will need to take steps to prevent another heart attack.
What is the Connection?
Heart disease and depression are linked in a number of ways. Some symptoms of depression, such as lack of energy, can make it harder to take care of your health. People who are depressed may be more likely to:
- Drink alcohol, overeat, or smoke to deal with feelings of depression
- Not exercise
- Feel stress, which increases the risk for abnormal heart rhythms and high blood pressure.
- Not take their medicines correctly
All of these factors:
- Increase your risk of having a heart attack
- Increase your risk of dying after a heart attack
- Increases your risk of being readmitted to the hospital
- Slow down your recovery after a heart attack or heart surgery
Signs of Depression
It is pretty common to feel down or sad after having a heart attack or heart surgery. However, you should start to feel more positive as you recover.
If the sad feelings do not go away or more symptoms develop, do not feel ashamed. Instead, you should contact your health care provider. You may have depression that needs to be treated.
Other signs of depression include:
- Feeling irritable
- Having trouble concentrating or making decisions
- Feeling tired or not having energy
- Feeling hopeless or helpless
- Trouble sleeping, or sleeping too much
- A big change in appetite, often with weight gain or loss
- A loss of pleasure in activities you usually enjoy, including sex
- Feelings of worthlessness, self-hate, and guilt
- Repeated thoughts of death or suicide
Treating Depression
Treatment for depression will depend on how severe it is.
There are two main types of treatments for depression:
- Talk therapy. Cognitive behavioral therapy (CBT) is a type of talk therapy commonly used to treat depression. It helps you change thinking patterns and behaviors that might add to your depression. Other types of therapy may also be helpful.
- Antidepressant medicines. There are many kinds of antidepressants. Selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs) are the two most common types of medicines used to treat depression. Your provider or therapist can help you find one that works for you.
If your depression is mild, talk therapy may be enough to help. If you have moderate to severe depression, your provider may suggest both talk therapy and medicine.
What you can do
Depression can make it hard to feel like doing anything. But there are ways you can help yourself feel better. Here are a few tips:
- Move more. Regular exercise can help reduce depression. However, if you are recovering from heart problems, you should get your provider's OK before starting to exercise. Your provider may recommend joining a cardiac rehabilitation program. If cardiac rehab is not right for you, ask your provider to suggest other exercise programs.
- Take an active role in your health. Studies show that being involved in your recovery and overall health can help you feel more positive. This includes taking your medicines as directed and sticking to your diet plan.
- Reduce your stress. Spend time each day doing things you find relaxing, such as listening to music. Or consider meditation, tai chi, or other relaxation methods.
- Seek social support. Sharing your feelings and fears with people you trust can help you feel better. It can help you better handle stress and depression. Some studies show it may even help you live longer.
- Follow healthy habits. Get enough sleep and eat a healthy diet. Avoid alcohol, marijuana, and other recreational drugs.
When to Call Your Doctor
Contact your provider if:
- You hear voices that are not there.
- You cry often without cause.
- Your depression has affected your ability to participate in your recovery, or your work, or family life for longer than 2 weeks.
- You have 3 or more symptoms of depression.
- You think one of your medicines may be making you feel depressed. Do not change or stop taking any medicines without talking to your provider.
If you or someone you know is thinking about suicide, call or text 988 or chat
You can also call 911 or the local emergency number or go to the hospital emergency room. DO NOT delay.
If someone you know has attempted suicide, call 911 or the local emergency number right away. DO NOT leave the person alone, even after you have called for help.
References
Beach SR, Celano CM, Huffman JC, Januzi JL, Stern TA. The psychiatric management of patients with cardiac disease. In: Stern TA, Freudenreich O, Smith FA, Fricchione GL, Rosenbaum JF, eds. Massachusetts General Hospital Handbook of General Hospital Psychiatry. 7th ed. Philadelphia, PA: Elsevier; 2018:chap 26.
Freedland KE, Carney RM, Lenze EJ, Rich MW. Psychiatric and psychosocial aspects of cardiovascular disease. In: Libby P, Bonow RO, Mann DL, Tomaselli, GF, Bhatt DL, Solomon SD. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 99.
Version Info
Last reviewed on: 2/27/2024
Reviewed by: Thomas S. Metkus, MD, Assistant Professor of Medicine and Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
