Is it post-heart attack depression – or just feeling sad?

by Carolyn Thomas   ♥  @HeartSisters

One of the small joys of having launched this site is discovering by happy accident the wisdom of other writers – even when they’re writing on unrelated topics not remotely connected to my favourite subject which is, of course, women and our heart health. For example, I happened upon a link to Sandra Pawula‘s lovely blog called Always Well Within. Sandra teaches mindfulness meditation, and she lives in Hawai’i (note her correct spelling).

She also has a hubby and three cats. I don’t even know this woman, but I like her already.  And while scanning through her beautiful site, I was stopped cold by an article she called: “Why Sadness is the Key to True Happiness“.  

Something about this title stopped me because for quite some time, I’ve been ruminating (something heart attack survivors are apparently very good at doing!) on whether the word depression is actually the most accurate way to describe what hits many of us survivors following a cardiac event.

Mayo Clinic cardiologists estimate that up to 65% of those living with heart disease exhibit symptoms of depression, yet fewer than 10% are appropriately diagnosed. Psychologist Dr. Elvira Aletta has instead used the word grief to describe the symptoms experienced by patients newly diagnosed with a chronic illness like heart disease:

“Chronic illness means getting sick and being told it is not going away, and that stinks. Our bodies have suddenly freaked out on us, and we’ve lost control of the one thing we thought we could count on.”

But lately I’ve been mulling over the possibility of pure semantics being the culprit in post-heart attack mental health diagnostics here.

After I started writing recently about medical research on clinical depression, for example, I learned that most studies actually suggest that what we know as depression tends to be a naturally self-limiting mental health condition that generally improves over time with or without the pharmaceutical assistance of antidepressant drugs. For example, University of Connecticut researchers* examined 38 pharmaceutical company-funded studies involving over 3,000 depressed patients and found that those taking antidepressants did improve, but the improvement differences between the medicated and placebo-taking groups were actually described as “miniscule”.

Research reported in the British Journal of Cardiology last July also suggested that interventions for anxiety and depression in heart attack survivors are not particularly successful. Cardiac psychologist Dr. Stephen Parker (and a fellow heart attack survivor himself) believes:

“A supportive strategy is probably more effective, as would be education in anxiety reduction and strategies for the management of depression.

“I think the depression and anxiety following a heart attack are a bit different than the depression and anxiety that most therapists encounter, and both are going to be more resistant to treat because there are damn good reasons to feel anxious and depressed.

“A heart attack is a deeply wounding event, and it is a wound that takes a long time to recover from, whatever the treatment.”

The type of depression that occurs so frequently after a serious health crisis like a heart attack 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.

I’m now wondering if Sandra Pawula’s observations about sadness may also be added to the list of alternative descriptions of post-heart attack depression or grief.

Could it also be that it’s crushing sadness over this “deeply wounding event” that we feel after surviving a catastrophic cardiac event?

In addition, Sandra believes that:

“Sadness is not always as bad as it’s made out to be.  In fact, sadness can be the start of your journey directly to the heart of true happiness.”

Sandra offers three ways that sadness can help and empower us, and I believe that each applies to the experience of many heart patients:

1.  Sadness Has the Power to Introduce a Crack in Our Idea of Reality

What previously-invincible heart patient cannot relate to the gigantic ‘crack in our idea of reality’ that a cardiac diagnosis brings? We are often in utter shock and denial about the catastrophic experience of surviving a serious cardiac event, as we wail (silently!) “How can this be happening to ME of all people?”   Sandra reminds us:

“There is not a single person in this world who can escape from suffering.  Suffering is the fundamental characteristic of the way we lead our lives. There may be transitory moments of happiness when things go our way, but this happiness is not a long-lasting one. 

“All the tension of striving for what we want and rejecting everything else just brings more complications and more suffering: ‘I like this.  I don’t like that.  I want this.  I don’t want that.’

“We’re rarely satisfied for more than a moment.  Then we’re on to achieving a new goal, having the next experience, getting a better possession, or finding the right relationship.

“Sadness has the power to introduce a crack in our limited and limiting version of reality.  Maybe life isn’t all about wanting, getting, accomplishing, and possessing.

“Let sadness spark your life with new meaning and purpose.”

2. Let Your Heart Break Into a Million Pieces

Sandra believes that there’s nothing quite like experiencing pain and suffering to be better able to touch or feel the pain and suffering of others. I’ve seen that phenomenon frequently when I read what doctors write about becoming patients themselves. Heart attack survivors have often told me that it’s only after their own cardiac events that they became exquisitely empathetic to others with outwardly-invisible chronic illnesses like heart disease. Sandra observes:

“When sadness breaks open our heart, we become fully human. We see that your suffering and my suffering are the same.  Suffering is a common thread that unites all of humanity.  From recognizing this simple truth, a profound feeling of interconnectedness can arise.  This sense of interconnection can ignite the wish to bring happiness to others.”

3.  Nothing Ever Stays the Same for Even a Moment

Just when we’re feeling pretty cocky about our own Wonder Woman skills at multi-tasking, job-juggling, “having it all“, blahblahblah – we get blind-sided out of the blue by a catastrophic cardiac event, along with all the physical and emotional chaos that this diagnosis brings to the table. Sandra believes that one benefit of sadness is that it can introduce us to the beauty of impermanence while helping us learn to let go:

“Sadness comes when things change – a relationship ends, someone dies, we’re fired from a job, illness descends, a friend is physically hurt, a disaster happens.

“Change is the only constant in life.  Until we learn to accept change gracefully, we’ll always suffer.  There’s a blessing in embracing the beauty of impermanence. Through doing so, we will come to value every precious moment of this life and live in a far saner and more fulfilling ways.”

IMPORTANT NOTE: Make no mistake, dear readers: I would never want to minimize the devastating impact that ongoing feelings of depression, grief and sadness can have while we are recuperating from a cardiac event. Survivors should certainly take whatever steps they can to address severe symptoms, particularly if they continue unchanged for over one month.

We also know that there is an important link between women’s comparatively poorer outcomes when heart disease is accompanied by undiagnosed and severe mental health issues.

Treatment options should also include physical exercise and talk therapy, among other options* shown to successfully reduce symptoms for many.

Read Sandra’s original post called Why Sadness is the Key to True Happiness.

Her excerpts here and her three ways that sadness can help and empower us are from her blog Always Well Within, © Sandra Pawula 2010-11.

♥ This post was also picked up by the Prepared Patient Forum website on August 4, 2011.

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NOTE FROM CAROLYN: I wrote much more about the link between heart disease and mental health issues 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 (use the JHUP code HTWN to save 20% off the list price when you order).

See also:

• * 10 Non-Drug Ways to Treat Depression in Heart Patients
• When Are Cardiologists Going to Start Talking About Depression?
• How Expecting Recovery Can Help Heart Attack Survivors
• When Grief Morphs Into Depression: Five Tips For Coping With Heart Disease
• Depressed? Who, Me? Myths and Facts about Depression After a Heart Attack
• “I’m Not Depressed!” – And Other Ways We Deny the Stigma of Mental Illness After a Heart Attack

* Kirsch, I., & Sapirstein, G. (1998). Listening to Prozac But Hearing Placebo: A Meta-analysis of Antidepressant Medication. Prevention and Treatment, 1 (Article 0002a).

 

Q:  Your take on this –  is it depression, grief or sadness?

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