Heart Disease and Stress
Depression and stress place you at higher risk for heart disease. Reduce your risk by recognizing and managing both conditions. Here are the resources you’ll need to get started.
Research over the past two decades has shown that people with heart disease are more likely to suffer from depression than otherwise healthy people, and that people with depression are at greater risk for developing heart disease. Furthermore, people with heart disease who are depressed have an increased risk of death after a heart attack compared to those who are not depressed.
A study by Duke University Medical Center researchers suggests that the cumulative effect of the daily mental and emotional stresses of life reduces the heart's ability to respond appropriately to the outside world.
Depression is a serious medical condition that affects thoughts, feelings, and the ability to function in everyday life. Depression can occur at any age. NIMH-sponsored studies estimate that almost 10 percent of American adults, or about 19 million people age 18 and older, experience some form of depression every year. Although available therapies alleviate symptoms in over 80 percent of those treated, less than half of people with depression get the help they need.
Depression results from abnormal functioning of the brain. The causes of depression are currently a matter of intense research. An interaction between genetic predisposition and life history appear to determine a person's level of risk. Episodes of depression may then be triggered by stress, difficult life events, side effects of medications, or other environmental factors. Whatever its origins, depression can limit the energy needed to keep focused on treatment for other disorders, such as heart disease.
Symptoms of Depression include:
- Persistent sad, anxious, or "empty" mood
- Feelings of hopelessness, pessimism
- Feelings of guilt, worthlessness, helplessness
- Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
- Decreased energy, fatigue, being "slowed down"
- Difficulty concentrating, remembering, making decisions
- Insomnia, early-morning awakening, or oversleeping
- Appetite and/or weight changes
- Thoughts of death or suicide, or suicide attempts
- Restlessness, irritability
If five or more of these symptoms are present every day for at least two weeks and interfere with routine daily activities such as work, self-care, and childcare or social life, seek an evaluation for depression.
* Depression may make it harder to take the medications needed and to carry out the treatment for heart disease.
* Depression and anxiety disorders may affect heart rhythms, increase blood pressure, and alter blood clotting.
* Depression and anxiety can also lead to elevated insulin and cholesterol levels.
These risk factors, with obesity, form a group of signs and symptoms that often serve as both a predictor of and a response to heart disease. Furthermore, depression or anxiety may result in chronically elevated levels of stress hormones, such as cortisol and adrenaline. As high levels of stress hormones are signaling a "fight or flight" reaction, the body's metabolism is diverted away from the type of tissue repair needed in heart disease.
Depression is a treatable condition of the brain. Effective treatment for depression is extremely important, as the combination of depression and heart disease is associated with increased sickness and death.
Treatment of depression often includes:
- Prescription antidepressant medications, particularly the selective serotonin reuptake inhibitors. These medications are generally well-tolerated and safe for people with heart disease. There are, however, possible interactions among certain medications and side effects that require careful monitoring. Therefore, people being treated for heart disease who develop depression, as well as people in treatment for depression who subsequently develop heart disease, should make sure to tell any physician they visit about the full range of medications they are taking.
- Specific types of psychotherapy, or "talk" therapy. Ongoing research is investigating whether these treatments also reduce the associated risk of a second heart attack. Preventive interventions based on cognitive-behavior theories of depression also merit attention as approaches for avoiding adverse outcomes associated with both disorders. These interventions may help promote adherence and behavior change that may increase the impact of available pharmacological and behavioral approaches to both diseases.
- Exercise. Exercise is another potential pathway to reducing both depression and risk of heart disease. A recent study found that participation in an exercise training program was comparable to treatment with an antidepressant medication (a selective serotonin reuptake inhibitor) for improving depressive symptoms in older adults diagnosed with major depression. Exercise, of course, is a major protective factor against heart disease as well.
Treatment for depression in the context of heart disease should be managed by a mental health professional—for example, a psychiatrist, psychologist, or clinical social worker—who is in close communication with the physician providing the heart disease treatment. This is especially important when antidepressant medication is needed or prescribed, so that potentially harmful drug interactions can be avoided. In some cases, a mental health professional that specializes in treating individuals with depression and co-occurring physical illnesses such as heart disease may be available.
Warning: Use of herbal supplements of any kind should be discussed with a physician before they are tried. Recently, for example, scientists have discovered that St. John's wort, an herbal remedy sold over-the-counter and promoted as a treatment for mild depression, can have harmful interactions with some other medications.
Treatment for depression helps people manage both depression and heart disease, thus enhancing survival and quality of life.
