If you have heart disease, you may be at risk for depression. In fact, if you've just had a heart attack, your risk for depression is three times greater than the general population.
Why is this important? Because, if left untreated, depression can lead to more complications and a higher risk of death in people with heart disease. That's why doctors are on the lookout for depression in people with heart disease or who have just had heart surgery. Although common, depression isn't normal and should be treated.
Ask yourself the following questions:
- Do I have little interest or get little pleasure in doing things that I once enjoyed?
- Do I feel down, depressed, or hopeless?
If you answered yes to either or both of these questions, tell your doctor. You may be suffering from depression. If you're depressed, treatment can help.
Why are people with heart disease and depression more likely to do poorly?
The link between depression and heart disease has both biological and behavioral roots.
On the behavioral side, people who are depressed are less likely to make lifestyle changes needed to help heal. This includes quitting smoking, eating healthy, exercising, and losing weight. They are also less likely to take medications as directed or take part in cardiac rehab programs. Depression can be a powerful de-motivator. It can leave those who suffer from it with a sense of hopelessness: "Why bother?"
On the biological side, some studies have shown that people with depression tend to have higher blood levels of markers that may show inflammation. Their blood might also be more likely to clot. And there is some evidence that problems with the heart rate and blood vessels may be more likely when depression complicates heart disease.
Depression has also been linked to other cardiovascular risks, such as insulin resistance, high blood pressure, obesity, increased cigarette smoking, alcohol abuse, and physical inactivity.
What kind of treatment works for depression in people with heart disease?
- Medications. Medicines called serotonin reuptake inhibitors (SSRIs) are shown to be safe and effective for moderate, severe, or recurrent depression for many people with heart disease.
- Psychotherapy. Cognitive behavioral therapy is a form of "talk" therapy that helps battle depression. It can be used alone or with medications. In this form of therapy, you and your therapist examine your patterns of thinking. You identify patterns that are hurtful and lead to depression. Then you replace them with more helpful thinking.
- Exercise. An exercise program, especially if it is supervised or part of cardiac rehab, can help your heart and ease symptoms of depression. Many heart patients are concerned about the safety of exercise. Under supervision by your doctor, exercise is usually safe and enjoyable. It keeps you fit, elevates your mood, and improves how well your heart works. Check with your doctor to see what the level of activity is right for you.
What happens after I start getting treated for depression?
Your doctor will continue to monitor you for any further signs of depression. Talk to your doctor if you have any problems with your treatment or if you continue to feel down. Do not stop any medication without first talking to your doctor.
Created on 11/20/2003
Updated on 06/20/2011
- Blumenthal JA, Lett HS, Babyak MA, et al. Depression as a risk factor for mortality after coronary artery bypass surgery. Lancet. 2003;362(9384):604-609.
- Mitka M. Routine depression screening advised for patients with coronary heart disease. Journal of the American Medical Association. 2008;300(20):2356-2357.
- Lichtman JH, Bigger Jr. JT, Blumenthal JA, et. al. AHA science advisory. Depression and coronary heart disease. Recommendations for screening, referral, and treatment. Circulation. 2008;118:1768-1775.
- National Alliance on Mental Illness. Treatments and services: cognitive-behavioral therapy.