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Along with a number of cardiovascular disciplines, Dr. Ziegelstein specializes in the study, diagnosis, and treatment of patients with heart disease and depression. Learn more about Dr. Ziegelstein.
Depression and heart disease are among the most disabling diseases we face. They are both very widespread among the general population and often occur simultaneously in the same individual.
There is thought to be a two-way relationship between heart disease and depression:
A percentage of people with no history of depression become depressed after a heart attack or after developing heart failure. And people with depression but no previously detected heart disease, seem to develop heart disease at a higher rate than the general population.
It is somewhat hard to prove that heart disease directly leads to the development of a first-ever episode of depression. That is because some people who have had previous episodes of depression may not have it formally diagnosed until they see their doctor for heart problems.
“What we can say with certainty is that depression and heart disease often occur together,” says Dr. Roy Ziegelstein, Executive Vice Chairman, Department of Medicine. “About one in five who have a heart attack are found to have depression soon after the heart attack. And it’s at least as prevalent in people who suffer heart failure.”
A heart attack can impact much more than a person’s heart. It can affect many other aspects of a person’s life, including:
Most heart attack survivors are able to return to the roles and responsibilities they had before their heart attack. When uncertainty and anxiety become debilitating and interfere with the daily functions of life, then the process of rehabilitation and recovery after the heart attack may need to include psychological and psychiatric support, and perhaps medication for depression.
Individuals recovering from a heart attack or other serious cardiac event can find many types of support. These include cardiac rehabilitation, social groups, and more specialized evaluation and treatment by psychologists, psychiatrists, and psychiatric social workers.
People with depression or who are recovering from a heart attack have a lower chance of recovery and a higher risk of death than people without depression. The reasons range from how the individual behaves to how the body reacts:
Maintaining a positive attitude about treatment and holding the belief that our actions can have a beneficial effect on our own health
are very important. A person’s attitude seems to have a powerfully favorable effect on their ability to make behavior and lifestyle changes that are often necessary to reduce the risk of having future heart problems. A person’s attitude also influences the response to treatment. Two terms that are used when discussing the effect of a positive mental state on heart disease are called “healthy adherer” effect and “self-efficacy.”
Heart disease and depression often carry overlapping symptoms such as fatigue, low energy, and difficulty in sleeping and carrying on the daily rhythms of life. So it’s not surprising that sometimes symptoms of depression are thought of by the patient, the patient’s family, and the cardiologist as being due to heart disease.
Many members of the medical community have stressed the importance of having patients, families, and physicians gain a greater awareness of the prevalence of post-heart attack depression. Physicians need to understand the importance of treating depression, since it is treated differently from heart disease.
Meeting this challenge can result in a vital communication between patient and physician that can start with something as simple as, “I wonder if what I’m feeling is from depression.”
Depression is generally more common in women than in men, so women with heart disease are more likely to develop depression. Heart disease tends to affect older individuals, and approximately one third of women recovering from a heart attack live alone, with no immediate family member or spouse to turn to for physical and emotional support.
“It’s important for all of us as healthcare providers to recognize that while we can’t necessarily change someone’s living situation or stress level, we can recognize their unique circumstances,” says Dr. Ziegelstein. “We can work with our patients on this individual level to help them cope with life in healthier ways.”