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Depression After Heart Attack

Definition

Depression is a medical condition that leads to intense feelings of sadness or despair. These feelings do not usually go away by themselves.

What is going on in the body?

Several factors can make a person feel depressed after a heart attack. The stress of being in the hospital, the fear of another heart attack, and the reality of having to make lifestyle changes can all contribute. If the person had to have bypass surgery, he or she will have to endure a long recovery period. This could include being out of work for up to six weeks.

Risks

What are the causes and risks of the condition?

There are many theories about what causes depression. Depression may be caused by any of the following:
  • chronic illnesses, especially cancer, arthritis, heart disease, or stroke
  • certain medications, including antibiotics and medicines used to treat acne
  • changes in brain chemicals
  • heredity
  • hormonal changes
  • lack of sunlight
  • major stresses
  • negative thinking patterns
Risk factors for depression include the following:
  • alcohol abuse
  • drug abuse and addiction
  • hormonal changes
  • job strain
  • personal or family history of depression
  • personal history of a suicide attempt
  • stress
Depression and heart attack have a complex relationship. People with a history of depression have a much higher incidence of heart attacks than people without depression. A person is more at risk for depression after a heart attack if he or she has suffered from depression in the past.

Prevention

What can be done to prevent the condition?

Sometimes depression is not preventable. The following steps reduce a person's risk of depression.
  • Avoiding alcohol and illegal drugs.
  • Avoiding cigarette smoking.
  • Getting prompt treatment for other psychiatric disorders.
  • Seeking effective treatment for chronic diseases.
  • Talking with a counselor if major trauma has been experienced.
Depression can lead to suicide. The lifetime risk of suicide for a person with depression is about 15 percent. It is important to recognize and treat the condition early. Individuals should be encouraged to seek help from a physician, licensed counselor or psychiatrist if they are concerned about depression. Conversations with clergy members, trusted friends, and family members are important and very helpful, but do not substitute for the clinical care needed to treat depression.

Diagnosed

How is the condition diagnosed?

A person who shows signs of depression after a heart attack should have a comprehensive evaluation. The evaluation may include a medical history, physical examination, and laboratory tests.

Long Term Effects

What are the long-term effects of the condition?

Following a heart attack, people with depression are less healthy and functional than those without depression. Recent research findings include the following:
  • People who are depressed after a heart attack rate their physical health lower than those who are not depressed.
  • People with depression after a heart attack report a significantly lower quality of life than nondepressed individuals.
  • Depression significantly increases a person's risk of dying from heart disease.
  • Depressed women with chest pain were three times more likely to smoke than other women with chest pain.
  • Depressed women with chest pain were four times more likely to be impaired in their daily activities than women without depression.
  • People who have depression are at much higher risk for stroke, further heart attacks, and heart disease than people who don't have depression.
People who suffer from depression after a heart attack are less likely to make the lifestyle changes necessary to decrease the risk of another heart attack. These changes include the following:
  • getting regular exercise
  • lowering intake of dietary fat and cholesterol
  • reducing stress
  • quitting smoking

Other Risks

What are the risks to others?

Depression is not contagious and poses no risk to others. Depression often runs in families.

Treatments

What are the treatments for the condition?

The two most common ways of treating depression are with antidepressant medications and psychotherapy. Often a combination is used. Occasionally a person must be hospitalized for intense treatment or for his or her own safety.
Antidepressant medications are effective in the following ways.
  • They increase the person's ability to function in daily life.
  • They lower the risk of suicide.
  • They make the person feel better.

The following types of medications are used to treat depression:

  • selective serotonin reuptake inhibitors (SSRIs), including paroxetine HCl (i.e., Paxil, Pexeva) and fluoxetine HCl (i.e., Prozac, Serafem)
  • monoamine oxidase inhibitors (MAOIs), such as phenelzine sulfate (i.e., Nardil) and tranylcypromine sulfate (i.e., Parnate)
  • other antidepressants, such as nefazodone (i.e., Serzone) and venlafaxine (i.e., Effexor)
  • tetracyclic antidepressants, such as maprotiline HCl and mirtazapine (i.e., Remeron)
  • tricyclic antidepressants (TCAs), including amitriptyline, nortriptyline HCl (i.e., Aventyl, Pamelor) and desipramine HCl (i.e., Norpramin) are not advised by many experts in patients after a heart attack or with cardiovascular disease.
Psychotherapy can help people do the following:
  • cope better with having depression
  • feel less alone
  • improve relations with family, friends, and coworkers
  • learn about depression and how it affects them
  • learn to recognize and avoid situations that can bring on a depressive episode
  • learn to view the world and others more positively and more realistically
  • positively address problems that they may be facing
  • stop episodes of depression early by recognizing warning signs and symptoms

Side Effects

What are the side effects of the treatments?

Antidepressants may cause mild and usually temporary side effects in some people. Following are the most common side effects:
  • agitation
  • constipation
  • dizziness
  • drowsiness
  • insomnia
  • dry mouth
  • nausea

After Treatment

What happens after treatment for the condition?

An individual can help prevent relapses by living a healthy lifestyle. Following are some important parts of a healthy lifestyle:
  • avoiding alcohol, illegal drugs, and smoking
  • doing regular exercise
  • eating a balanced diet, following the food guide pyramid
  • finding ways to manage stress
  • finding a support system for dealing with depression
  • getting enough rest

Monitor

How is the condition monitored?

Once a person has an episode of depression, he or she is at higher risk for further episodes. Any new or worsening symptoms should be reported to the healthcare provider. The provider may recommend regular visits to monitor symptoms. The provider may also order blood tests to monitor the levels of medications.

Sources

Professional Guide to Diseases, Sixth Edition. Springhouse: Springhouse Corporation, 1998.

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"Depression After Heart Attack or Bypass", [hyperLink url="http://www.allhealth.com/heartwatch/feb99/nejm/0,4802,2120_123965,00.html" linkTitle="www.allhealth.com/heartwatch/feb99/nejm/0,4802,2120_123965,00.html"]www.allhealth.com/heartwatch/feb99/nejm/0,4802,2120_123965,00.html[/hyperLink]

People Depressed after Heart attack Less Likely to Make recommended Behavior changes to reduce risk", [hyperLink url="http://hopkins.med.jhu.edu/NewsMecia/press/1997/Novermber/971112.htm" linkTitle="hopkins.med.jhu.edu/NewsMecia/press/1997/Novermber/971112.htm"]hopkins.med.jhu.edu/NewsMecia/press/1997/November/971112.htm[/hyperLink]

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