If you have suffered a heart attack you are probably worried about two things: the immediate threat to your life and the long-term fear that heart disease will affect the way you live. Many heart attack victims feel angry that the attack happened to them, guilty about not taking better care of themselves or worried whether they will survive the attack or suffer another one. Result: They become depressed. In fact, one of every two people who has had a heart attack experiences symptoms suggestive of depression during or slightly after their recovery.
Anxiety may develop early, during your first few days in a coronary care unit. Anxiety often eases once you begin to understand that you have survived and can make a complete recovery. Depression, however, is not so easily relieved. Heart attack patients who experience depression after recovery say they are most worried that their attack will limit their lifestyle.
Depression can be very hard to detect and diagnose. Heart attack patients often have a general feeling of weakness or uneasiness. Some find that the tranquilizers or other medications they are taking cause them to feel "blue." But these feelings are different from the full-blown depression many heart attack victims experience.
Signs of depression include:
- Depressed mood (despondent, pessimistic about the future, hopeless, withdrawn)
- Marked loss of interest or pleasure
- Feelings of worthlessness or guilt
- Change in appetite or weight
- Loss of energy
- Fearfulness of activity
- Lack of interest in personal hygiene
- Lack of interest in sex
- Easily distressed
- Agitation or restlessness
- Inability to concentrate, make decisions, remember or comprehend instructions
- Thoughts of death or suicide
- Failure to return to work.
Depression may also affect whether you stick with the lifestyle changes recommended by your doctor to reduce the risk of a second heart attack. Many people who are depressed lack the energy and motivation to exercise regularly, and they may feel their situation is too hopeless to change.
The depression-disease connection
While there is increasing appreciation that many people with heart disease go through a period of depression, doctors now believe that the link between these two conditions may be stronger than previously thought. Many research studies suggest that people with heart disease and depression have a worse outlook than those with heart disease and no depression. But the experts are unable to agree on how depression may increase your risk of heart disease.
Some researchers hold that hormones released during depression create biochemical changes that stress the heart and circulatory system and lead to heart disease. Others believe that a bout of depression before or after a heart attack may leave people so emotionally hollow that they forsake their health, ignore recommendations to alter their lifestyle and forget to take their medications. In a sense, it is a debate over whether the biology of depression or the ensuing behavior is more likely to lead to heart disease.
Regardless of the cause and effect relationship, depression takes its toll on the heart. One study found that depressed patients with heart disease were twice as likely to require surgery within one year as heart disease patients who were not depressed. Another study of people without heart disease found that depressed individuals were four times more likely to suffer a heart attack within the following 14 years than those who were not depressed.
One explanation for the increased risk of heart attacks among depressed people is that, like stress, depression triggers the body's fight-or-flight responses. Depression, it turns out, is a two-faced condition: On the surface, depressed people appear lethargic, tired and sluggish, yet under the surface their hormones are raging. They often sleep less, wake earlier, lose their appetite and secrete much higher levels of stress hormones--cortisol, norepinephrine and epinephrine--than nondepressed people. In fact, they are in a state of constant chemical arousal. Alone, this chronic state of arousal may be enough to increase the risk of heart disease; combined with the well-known behavioral effects of depression, the effect can be devastating. In a sense, heart disease patients who are depressed are fighting a battle on two fronts. They are more likely to ignore their doctor's recommendations to control their disease, and they must further contend with the biochemical effects of depression on the heart.
One thing that becomes clear is that increased levels of dangerous stress hormones level off in patients undergoing treatment for depression. Talk with your doctor about your symptoms. He or she will make recommendations based upon the severity of your symptoms.
For moderate to severe depression, a combination of psychotherapy and medication is most helpful. Many of the newer medications to treat depression are safe in people with heart disease. The most commonly prescribed antidepressants are in the group known as selective serotonin reuptake inhibitors (SSRIs). Examples include fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil) and citalopram (Celexa).
What family members can do
Family members need to adjust to their loved one's new life after a heart attack. The first few weeks after a patient comes home can be particularly trying. You may be afraid that something you do or say can trigger another attack. Or you may mistakenly imagine that it was something you did that precipitated the first attack.
There is no one answer for the feelings you may have after a spouse or parent suffers a heart attack. Open, frank communication of everyone's feelings is the best route. Try to learn as much as you can about heart attacks and recovery. By following your doctor's advice, you can help get through the recovery period and back on track to a normal life.
In addition, family members should be aware of the signs of a heart attack and have a heart attack plan in case your loved one experiences a second attack. Recent changes in how to perform cardiopulmonary resuscitation (CPR) make it much simpler to learn.