Women suffering from depression have higher risks of developing heart disease, and women with heart disease have higher risks of becoming depressed. I find this reality a bit depressing…
I was stunned to find myself in that latter group within weeks of my own heart attack. With no personal experience of depression, I knew something was terribly wrong with me, but I couldn’t put my finger on exactly what that might be. I had just survived a massive heart attack – shouldn’t I be feeling fabulous and grateful?
Instead, I felt exhausted, distressed, weepy, unmotivated to even drag myself out of bed in the morning. I slept in my clothes. I forgot about basic personal hygiene like washing my hair, and I no longer cared about how I looked or how I smelled. All I wanted to do was crawl back under the covers.
I tried very hard to paste on my best happy face around my family and friends, but eventually I found simply making conversation so utterly exhausting that it just seemed easier to make excuses and avoid others entirely.
Desperate to just feel “normal” again, and by then having exhausted all of my paid sick leave and vacation days, I suffered through a dreadful month attempting a return-to-work trial (just half-days to start).
But I felt so debilitated, overwhelmed and anxious with the normal daily demands of my busy public relations job that every single day, I believed another heart attack was imminent. Finally dragged to my family doctor’s office by a concerned RN colleague, I was ultimately ordered off work on extended medical leave.
When I went to the world-famous Mayo Clinic five months after my heart attack, I learned that this kind of expert intervention is actually rare. It was a nurse at my workplace who could see that I needed help, not my (now former) family doctor. In fact, when I did ask my doc to refer me to a professional therapist, she stonewalled me, claiming that there was “a one-year waiting list”, a mistaken assumption that cost me months of needless suffering. The actual waiting list? Two days.
According to Mayo Women’s Heart Clinic cardiologists, fewer than 10% of women are appropriately diagnosed with depression following a cardiac event.
And women heart patients are almost 60% more likely to become depressed after their cardiac events than women without any history of heart disease.
The type of depression that occurs so frequently after a serious health crisis like a cardiac event is known as “situational depression”, or “stress response syndrome”. It’s what mental health professionals call an adjustment disorder that can strike within weeks following a traumatic life event as we struggle to make sense of something that makes no sense. The good news is that, unlike clinical depression, it typically tends to run its course over about a six-month period, often eventually fading even without treatment.
Unfortunately, many heart specialists may not have the time or the expertise to address depression, says cardiologist Dr. Sharonne Hayes, founder and director of the Mayo Women’s Heart Clinic.
“Cardiologists may not be comfortable with ‘touchy-feely’ stuff. They want to treat lipids and chest pain. And most are not trained to cope with mental health issues.”
Let’s consider depression in general. People who are depressed have symptoms that may include:
- intense sadness
- feelings of guilt or worthlessness
- extreme fatigue
- excessive crying
- lack of ability to enjoy normal activities
These symptoms can range from a few weeks (as in situational depression) to many months or longer (clinical depression). They can range from mild to severe, and a person’s ability to function in daily life may become severely impaired. The problem is alarming, and rarely well understood or treated.
Now let’s consider why doctors must start paying attention to signs of depression in all of their heart patients.
Heart patients who are struggling with depression are far less likely to:
- take take their cardiac meds as directed
- quit smoking
- eat a heart-healthy diet
- lose weight
- follow even the most basic of doctor’s orders
Failure to embrace these cardioprotective lifestyle decisions can significantly impact our risk of a future cardiac event. And I haven’t yet met a cardiologist who hasn’t been alarmed and frustrated by the high rates of “non-compliance“ among their patients (a dreadful and patriarchal word, by the way, that makes me and many patients cringe).
Patients who don’t take their statins, their beta blockers, their blood pressure meds as prescribed are a significant problem in cardiology. The World Health Organization estimates that only 50% of people actually take their medication therapy as prescribed. But are physicians suspecting depression as the culprit among these “non-compliant” patients? See also: Why Don’t Patients Take Their Meds As Prescribed?
Here are even more disturbing facts about depression. We know that women in general are twice as likely to develop depression compared to their male counterparts.
This higher overall risk, according to Dr. Nasreen Khatri of Toronto’s Baycrest Hospital, is likely due to a combination of factors, including:
- biological ones like the effects on the brain of hormonal changes during pregnancy
- social factors like the multiple roles women tend to play in modern society
- psychological ones like different coping styles
Dr. Khatri adds that many middle-aged women today are also caring for both their own children and elderly parents, thus increasing stress levels which in turn can lead to depression.
And depression itself appears to make women two times more susceptible to developing Alzheimer’s disease, for reasons that are not yet entirely clear. What may not be well known is that seven out of 10 new cases are women, ironically, explains Dr. Khatri – and these are the very people who more often than not take on the major responsibility for caring for dementia sufferers.
“Depression is very common among female patients following heart attacks,” according to Dr. Susmita Mallik of Emory University School of Medicine reporting in April’s Archives of Internal Medicine. However, younger women diagnosed with heart disease before the age of 60 are three times more likely to become depressed than male patients, Dr. Mallik says.
“Depression should not be considered a normal reaction after a heart attack. Both doctors and patients should be aware that depression is an important risk factor for adverse outcomes for cardiac event survivors.”
Dr. Nieca Goldberg, chief of Women’s Cardiac Care at Lenox Hill Hospital in New York City, agrees.
“This report is important, because it underscores the importance of evaluating the psychological issues that often accompany a heart attack.”
Dr. Goldberg says younger women (< 60) are more susceptible to depression because a heart attack is such a major psychological trauma, especially when it occurs at a younger age.
“It’s a life-changing, stressful event. It’s a shocking experience. There are constant concerns among survivors about whether they are going to be able to return to their usual life.”
Dr. Goldberg also noted the well-documented connection between the mind and the heart.
“Clearly, depression does influence recurrent heart disease.”
Canadian research published in the European Journal of Cardiovascular Nursing found that 74% of women diagnosed with post-cardiac event depression still had impaired physical and social functioning one year after their heart attack, impeding their overall recovery and independence.
Researchers suggest that women may be more at risk of depression because, compared to male patients, they are:
- less likely to be appropriately assessed
- referred to attend cardiac rehabilitation programs less frequently
- not as supported in making lifestyle changes needed to recover from a heart attack
Women also can feel under pressure to return immediately to work and to their usual demanding role of family caregivers, instead of accepting the fact that they are the ones who may need care during their months of recovery.
The Canadian report’s lead author, Dr. Colleen Norris, of the Faculty of Nursing at the University of Alberta, says depression in women with coronary artery disease has “flown under the radar for far too long.” The key here, says Dr. Norris, is that doctors must look for symptoms of depression in patients who are undergoing treatment for heart problems, particularly in women.
Treatment for depression in all patients can be quite effective – usually a combination of counseling, support programs and, if needed for severe depression, anti-depressant medications. There are many non-drug options for treating the situational depression often experienced by heart patients. These can not only help to ease the symptoms of depression, but they can also improve the longterm health of heart patients. Says Dr. Norris:
“It is so important that we start addressing the depressive status if we wish to see improvements in outcomes of our female patients with coronary artery disease.”
When the former Globe and Mail reporter Jan Wong wrote about her own journey with debilitating depression in the memoir Out of the Blue, she described the ultimate life lessons that depression had taught her:
“The big life lessons are that you can have clinical depression and you can get over it. It’s completely treatable. It has an end.
Second life lesson: you’ll probably be stronger when you come out of it than you were before.
The third life lesson is you’ll probably be happier because you leave it behind and you will find a new life.
The fourth lesson: family matters. Everything else is extra.”
NOTE FROM CAROLYN: I wrote much more about the link between heart disease and depression in Chapter 5 of my book, “A Woman’s Guide to Living with Heart Disease” . You can ask for it at your local bookshop, or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from my publisher, Johns Hopkins University Press (and use the code HTWN to save 20% off the list price when you order).
- 10 Non-Drug Ways to Treat Depression in Heart Patients
- When are Cardiologists Going to Start Talking About Depression?
- Depressed? Who, Me? Myths and Facts About Depression after a Heart Attack
- Is it Post-Heart Attack Depression – or Just Feeling Sad?
- Women Heart Attack Survivors May Be As Psychologically Traumatized as Victims of Violence
- The New Country Called ‘Heart Disease”
- Not Just For Soldiers Anymore: Post Traumatic Stress Disorder After A Heart Attack
© Carolyn Thomas www.myheartsisters.org