Stress, anxiety and depression and its impact on Heart Disease Written with: Leo Pozuelo, MD Department of Psychiatry and Psychology It is common for you to feel sad or depressed after a heart attack, cardiac surgery or procedure, recent hospitalization, or new diagnosis of heart disease. These emotions may be the result of not knowing what to expect or not being able to do simple tasks without becoming overly tired. Temporary feelings of sadness are normal, and should gradually go away within a few weeks, as you get back to your normal routine and activities. Sometimes, however, a depressed mood can prevent you from leading a normal life. When a depressed mood is severe and accompanied by other symptoms that persist every day for 2 or more weeks, treatment is necessary to help you cope and recover. What is the role of depression in patients with cardiovascular disease?Up to 15 percent of patients with cardiovascular disease and up to 20 percent of patients who have undergone coronary artery bypass graft (CABG) surgery experience major depression.¹ Studies have shown that mental stress has a negative effect on a person’s heart health. In particular:
If you’re recovering from heart surgery, a heart attack, or another heart condition, temporary feelings of sadness and a depressed mood are common for the first few weeks. However, treatment is necessary when depression is severe and accompanied by other symptoms (including withdrawal from activities, not responding when visiting with family and friends, increased negative thoughts and tearfulness). Without treatment, depression can become worse. For heart patients, depression can contribute to an increased risk of heart attack and coronary disease. Talk to your health care provide who can diagnose and start depression treatment with safe antidepressants. Your health care provider also can refer you to a mental health specialist who can provide other appropriate treatment when necessary. When depression is negatively affecting your life — such as causing increased difficulties with relationships or performance at work or at home, it is important for you to get help to prevent things from getting worse. More specific reasons to seek help include:
Depressive disorders result from a mix of factors
The biggest hurdle to diagnosing and treating depression is recognizing that someone is suffering from it. Unfortunately, approximately half of the people who experience depression are never diagnosed or treated for their illness. And not getting treatment can be life-threatening: up to 10 percent of people battling depression commit suicide. Your health care provider can evaluate your condition by asking you to describe your symptoms. Since patients recovering from a medical illness, hospitalization or surgical procedure experience some common symptoms of depression including fatigue and insomnia,your health care provider will pay attention to these additional symptoms of depression:
Sometimes, symptoms of depression can be made worse by certain medications, a physical disorder, virus or illness. Your health care provider may perform a physical exam or laboratory tests to determine if there is a physical cause for your depressive symptoms. Your health care provider will also evaluate your personal and family medical history, as well as any history of drug or alcohol use. Although there are no specific blood tests used to diagnose depression, there are various screening tools and diagnostic criteria used to make the proper diagnosis. The U.S. Preventive Services Task Force has recommended that clinicians ask two screening questions for depression, known as the Patient Health Questionnaire (PHQ-2), including:
If you answer yes to both of these questions, there is a high likelihood of clinical depression, and your health care provider can provide recommendations to help you get the treatment you need. Your health care provider can also administer the Patient Health Questionnaire 9 (PHQ-9), a nine-item question list that can better define your depression and guide treatment.
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