Heart Sick and Feeling Blue? Depression After a Heart Attack

February is American Heart Health Month and an ideal time to highlight the little-known relationship between heart disease and depression. Statistics indicate that depression is three times more likely following a heart attack. This means that 15% to 20% of heart attack patients compared to 6.7% of adults in the general population have depression. And those with depression after a heart attack are more likely to have another heart attack. Factors such as poor medication compliance, smoking, inactivity, and increased stress hormones contribute to poor prognosis after a heart attack, and these issues also emerge for people who are depressed.

Because decreased energy, sleep issues, and appetite changes are not uncommon following a heart attack, people might think these symptoms are just "normal," and in fact they might be. "But depression can decrease motivation to engage in healing behaviors," says Dr. Sue Ei, a licensed psychologist in Bloomsburg, PA, "and this could lead to another heart attack. So it's important to consider whether your symptoms are just a normal response to a health crisis, or if you could be depressed. Even those with no history of depression can experience depression symptoms."

Depression should only be diagnosed by a mental health or medical provider, but the following checklist can help you consider whether depression might be a problem.

• Have you been feeling down or blue for two weeks or more?
• Have you been feeling irritable or restless?
• Are you sleeping much more, or much less, than usual?
• Have you had appetite changes or significant weight changes?
• Are you less interested, or find less pleasure, in the activities you usually enjoy?
• Is it hard to get motivated?
• Are you letting your cardiac rehabilitation, or other important things slide?
• Do you feel a sense of hopelessness, worthlessness or guilt?
• Is it harder to focus or concentrate when necessary?
• Do you have thoughts of not wanting to live anymore?

Ask your healthcare provider to evaluate you for depression, or request a referral to a psychologist or other mental health practitioner. The good news is that treating your depression can help you regain the energy and motivation you need to make healthy lifestyle changes and reduce heart attack risk.

The Pennsylvania Psychological Association offers these suggestions:

• Find a psychologist or other mental health provider who does Cognitive Behavioral Therapy (CMT), an effective treatment approach for depression.
• Go to your cardiac rehab appointments - especially when you don't feel like going. Exercise is important not only for your heart, but it's been shown to reduce depression as well.
• Talk to your psychologist or your rehab team about motivation, and figure out what motivates you to get better. Carry reminders of these motivators to help when you are struggling.
• Let others support you. You may need a ride, extra help, someone to talk to, or to just have some fun and forget about health concerns for a while. Studies show that social contact is good for you, and people like to help.
• Talk with your physician about whether a medication intervention is appropriate for you.

For more information about depression and heart health, check out these resources:

• National Institute of Mental Health (NIMH) – Depression and Heart Disease
• American Psychological Association – Depression
• CDC – February is American Heart Month

To learn more about mind/body health, visit the Pennsylvania Psychological Association's website, www.papsy.org, and the American Psychological Association's Consumer Help Center at www.APAhelpcenter.org.

Western Pennsylvania Guide to Good Health. All rights reserved.