Depression and heart disease: A double-edged sword?

Everyone goes through periods of feeling gloomy, irritable, or listless at least once in a while. And these emotions are perfectly normal after a diagnosis of a serious health problem such as heart disease. But if those unpleasant feelings drag on for weeks and gradually erase your sense of well-being, you may have depression.

Over a lifetime, about one in five Americans is affected by depression. But the risk of depression in people who’ve had a heart attack is three times as high as the risk among the general population.

“A heart attack is a life-changing event, so it’s very common to feel overwhelmed, depressed, and anxious afterward,” says cardiologist Dr. Alyson Kelley-Hedgepeth, co-director of the Women’s Program at the Harvard-affiliated Lown Institute. Making positive changes to your lifestyle can go a long way toward improving both your mood and your heart health. But antidepressants and therapy are important, too. These treatments can help ease symptoms of depression, which can give people the motivation to make changes, she says.

Recognizing the problem

Thanks to broader recognition of the brain-heart connection, more doctors are screening their patients for depression, using a simple screening test (see “Do you have depression?”). “When I ask my patients these questions, it can be very humbling. Both men and women are willing to share their feelings and talk about their emotions,” says Dr. Kelley-Hedgepeth. If your cardiologist or primary care provider doesn’t ask you about symptoms of depression, don’t hesitate to volunteer that information.

People with depression can find it hard to muster the energy to stick to healthy habits, including choosing and preparing healthy foods, exercising, and taking prescribed medications on schedule. Depression often goes hand in hand with anxiety, and both conditions can boost stress hormone levels. Elevated levels of one of the main ones, cortisol, can raise blood pressure and blood sugar levels. Depression also appears to increase inflammation, a known contributor to the buildup of cholesterol-filled plaque. It also causes blood cell fragments known as platelets to become more “sticky” and likely to form clots in the bloodstream. All of these changes leave people more vulnerable to a heart attack.

Do you have depression?Answering “yes” to either or both of the following questions means you’re very likely to have depression.During the past month, have you often been bothered by feeling down, depressed, or hopeless?During the past month, have you often had little interest or pleasure in doing things that you have previously enjoyed?Other symptoms of depression — which often occur most of the day, nearly every day — includefatigue and lack of energyreduced appetite (or increased cravings for food)difficulty sleepingfeelings of worthlessness or guiltangry outbursts, irritability, or frustrationtrouble concentrating and remembering things.

A range of treatments

Fortunately, there are many treatment options for people with depression and heart disease. According to a 2020 review in the Journal of the American Heart Association, antidepressants known as selective serotonin reuptake inhibitors (SSRIs) help ease depression in people with coronary artery disease; sertraline (Zoloft) has the best evidence to date. For some people, these drugs improve symptoms enough to enable other positive changes, and people don’t necessarily need to stay on them for extended periods of time, Dr. Kelley-Hedgepeth says. Talk therapy, especially cognitive behavioral therapy, has also proved helpful. This therapy is designed to help people recognize and change ingrained, negative thoughts or behaviors.

Three lifestyle changes can benefit both mental and cardiovascular health: regular exercise; high-quality, sufficient sleep; and mind-body therapies that encourage relaxation, such as meditation. “I encourage exercise for all my patients, and it’s very helpful for depression, too,” says Dr. Kelley-Hedgepeth.

Chronic sleep problems plague many people, especially those who are worrying about their health. For many people, isolation during the COVID-19 pandemic has worsened underlying depression and stress, which can further exacerbate sleep issues, Dr. Kelley-Hedgepeth notes. Practices that may help include mindfulness meditation, which teaches you to pay attention to your thoughts, emotions, and bodily sensations — especially your breathing. “It can be particularly helpful for people who wake up at 2 a.m. with a racing mind,” she adds.

Bible verses for today’s meditation and inspiration: Matthew E. McLaren

 “Finally, brothers and sisters, whatever is true, whatever is noble, whatever is right, whatever is pure, whatever is lovely, whatever is admirable–if anything is excellent or praiseworthy–think about such things.” – Philippians 4:8

 “Therefore I tell you, whatever you ask for in prayer, believe that you have received it, and it will be yours.” – Mark 11:24

 “Anxiety weighs down the heart, but a kind word cheers it up.” – Proverbs 12:25

 “Who of you by worrying can add a single hour to your life?” – Luke 12:25

 “For I know the plans I have for you, declares the Lord, plans for welfare and not for evil, to give you a future and a hope.” – Jeremiah 29:11

“If you, then, though you are evil, know how to give good gifts to your children, how much more will your Father in heaven give good gifts to those who ask him!” – Matthew 7:11

 “A cheerful heart is good medicine, but a crushed spirit dries up the bones.” – Proverbs 17:22

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