Depression can sap the energy and motivation that people with heart disease need to get better. Studies show that depressed cardiac patients are less likely to take their medications, to quit smoking, or to attend cardiac rehabilitationall of which are important for recovery and survival.
How mood blocks cardiac recovery
A patient's ability to recover may have as much to do with his state of mind as the health of his heart, according to a long-term study of heart disease and depression at the University of California, San Francisco.
"Depression isn't just debilitating, but it can also worsen chronic conditions," says the leader of the study, Mary Whooley, MD, professor of medicine and epidemiology at UCSF and the San Francisco Veterans Affairs Medical Center. In this video, Laurence Sperling, MD, a preventive cardiologist at Emory University in Atlanta, explains that depression combined with heart disease is physical as well as psychological.
Any serious illness can darken a person's mood, but heart disease seems to be especially depressing, says Wayne Sotile, PhD, director of psychological services at the Wake Forest University Healthy Exercise & Lifestyle Programs and author of Thriving With Heart Disease (Free Press, 2003). "It's one of the few diseases where people have a fear of sudden death," he says.
Many heart patients concur. "I thought a lot about dying. I'm 61 years old and wondered whether I'd wake up in the morning," says Barbara Forman of Englewood, Ohio. Five years after bypass surgery she still worries about her depression.
Depression masquerades as fatigue
But patients don't always recognize depression and doctors don't always screen for it. Both may blame symptoms on fatigue from the heart disease, surgery, and the side effects of heart medications. That's why Leo Pozuelo, MD, associate director of the Bakken Heart-Brain Institute at the Cleveland Clinic suggests that cardiac patients ask themselves two important questions: Over the past two weeks, have you felt little interest or pleasure in doing things? and Over the past two weeks, have you felt down, depressed, or hopeless? If the answer is yes to both, you should seek help from a mental health expert, says Dr. Pozuelo.
This self-test worked for Forman, who went back to work after her heart surgery, promptly gained 40 pounds, and felt awful. "I couldn't focus on things," she says. "I felt like I had adult ADD. I just felt really overwhelmed with work, with everything."
Finally Forman realized her depression was not normal and sought help. Her family doctor prescribed psychotherapy and an antidepressant. "It has made all the difference in the world," she says. "It's like a weight has been lifted."