Depression After A Cardiac Event or Diagnosis

Updated:Nov 6,2013

Water Flowing In River Cardiovascular disease can trigger depression; counseling and medication can help beat it.

When someone has a heart attack, heart surgery or stroke, the immediate concern obviously is physical health.

Once survivors start down the road to recovery, it’s important to monitor their mental health, too.

While depression affects an estimated 7 percent to 10 percent of Americans ages 18 and older, studies show that up to 33 percent of heart attack patients end up developing some degree of depression, said Barry Jacobs, Psy.D., a clinical psychologist and director of Behavioral Sciences at the Crozer-Keystone Family Medicine Residency Program in Springfield, Pa.

“The big message is that people need to be aware of this connection,” said Dr. Jacobs, who is also an American Heart Association volunteer. “The second message is that many treatments are available. No one needs to suffer.”

Signs and Symptoms

It makes sense that someone would be sad while recovering from heart disease. But how long it lasts, and how debilitating it becomes, indicates whether someone is processing natural feelings (such as general sadness or fear of facing mortality) or slipping into a depressed state.

Depression doesn’t show up on an X-ray, like a broken bone. It has to be detected through behaviors and attitude.

“We don’t expect everyone to get off course in their lives,” Dr. Jacobs said. “Most people don’t – but some people do. If you are one of those people who just can’t get it going anymore – you don’t feel like getting out of bed and facing the day or you are irritable all the time – those are signs that maybe your response is depressive.”

The best indicator: Does the patient have the same zest for life he or she used to have?

“Have they stopped playing guitar, seeing friends, reading the newspaper?” Dr. Jacobs said. “If they are not enjoying the things that used to give them pleasure, that is a sign that should not be ignored.”

Other indicators are sleeping and eating; too much or too little of either could be troublesome.

What can be done?

The best start is meeting with a primary care physician. Your doctor can provide a nine-question screening test that is “very accurate in diagnosing depression, especially major depression,” Dr. Jacobs said.

The primary care physician will determine whether a mental-health specialist is needed and recommend one if necessary.

Depression and anxiety are among the 10 most-common diagnoses in primary care, so your physician is likely to have experience in this area.

“I think we do a better job diagnosing depression than we did a decade or two ago,” Dr. Jacobs said. “Mental-health problems are less stigmatized now. People also have a better appreciation that the mind and body work together. If we want our bodies to work well, we need to get our minds in order.”

Treatment Options

The best ways to beat depression are counseling, medication or – in many cases – both.

“The most common counseling looks at the thoughts people have that subconsciously affect their mood,” Dr. Jacobs said. “Are those thoughts rational or not? For instance, one such thought might be, `If I get stressed out at all, I’m going to die.’ Those people may withdraw from life because they fear it’s going to be too much. But that also ends up cutting them off from sources of nurturance.”

Patients may be taught ways to relax and relieve stress, such as breathing exercises or meditation.

A variety of mood-lifting medicines are another common option.

“The combination of medicine and counseling probably has the highest success rate,” Dr. Jacobs said.

Benefits of Treating, Risks of Not Treating

Depression can make physical problems worse. A depressed person is less likely to take care of physical health, cutting back on or skipping rehabilitation exercises and/or taking medication. Dr. Jacobs described this as “inertia taking hold.”

Once depression is treated, and a person’s energy and activity level increases, quality of life will rise, too.

So it’s all about taking that first step.

“The quicker we can identify people who have depression that is complicating the ability to get back to life and enjoy life, the better the chances of recovery,” Dr. Jacobs said. “We don’t want depression to get in the way of full physical recovery.

“The age-old advice is having a sound mind and a sound body. People have to work at that, especially after a heart attack. The goal is to live right, eat right and have a good attitude.”

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 Stress Management

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