When are cardiologists going to start talking about depression?

3 Jan

by Carolyn Thomas     @HeartSisters

I can vividly remember those early days and weeks at home after surviving a heart attack, especially that cold creeping anxiety around how I “should” be feeling. I had just survived what many do not: what doctors still call the “widow maker” heart attack. (By the way, note the gender semantics there, please: doctors are not calling this the widower maker”).

I was now resting comfortably, both of my darling kidlets had flown back home to be with their Mum, our home was filled with flowers, get-well cards and casseroles delivered by the daily line-up of concerned friends, family, neighbours and co-workers.

So why was I feeling so bleak inside, and even worse, now feeling guilty for all that bleakness? 

Shouldn’t I be deliriously happy and thankful now because I was alive, because I was so lucky to live near world-class cardiac care, because I had such a strong social support network of family and friends around to fuss over me?  Why was I so frighteningly tearful over every twinge I felt in my chest? Why was it becoming almost impossible to concentrate or to participate in conversations or to even drag my exhausted self out of bed every morning? Why had I simply stopped caring, day after day after day, about how I looked or how I smelled? Why was I no longer interested in, well . . . anything?

Ironically, being surrounded by so much love and attention actually made me feel even more broken: with all this caring, how dare I feel anything but a good patient’s appropriately cheerful dose of gratitude? Why couldn’t I just will myself to snap out of it?

It turns out, however, that what I was experiencing is actually remarkably common among heart patients.

When I was at Mayo Clinic five months later, I was shocked to learn there that up to 65% of heart attack survivors experience depression, yet fewer than 10% are appropriately identified.

The type of depression that occurs so frequently after a serious health crisis like a heart attack is often 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, and can often eventually fade even without treatment.

But before I was discharged from hospital after my heart attack, not one person in the CCU (the hospital’s intensive care unit for heart patients) had warned me of the reality of these mental health statistics. Not one doctor, not one nurse, not one janitor had said even one word to me about this very common problem.

Unfortunately, many heart specialists may not have the time or the expertise to address depression, according to cardiologist Dr. Sharonne Hayes, founder 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.”

The closest most cardiologists may come to identifying a bona fide mental health issue in their patients is through the common term “pump head”.  In February 2001, The New England Journal of Medicine documented the frequency and persistence of mental deterioration following coronary artery bypass surgery – dubbed pump head. This deterioration includes symptoms like mental sluggishness, personality changes and memory problems – not surprisingly, also the symptoms of clinical depression.

But in his column called Don’t Be So Sure It’s Pump Head” , cardiologist Dr. Richard Fogoros warns:

“It seems very likely that patients who actually have depression will be written off as having pump head. This would be a big mistake for two reasons. First, depression (unlike pump head) is treatable. Second, in cardiac patients, depression can be lethal if untreated. Thus, mistaking depression for pump head can be a fatal mistake.

“Cardiologists are not trying to cause harm when they fail to diagnose depression – they just don’t see it. They are focused, by their natures, on a completely different aspect of reality.

“The very nature of cardiologists is to embrace the concrete, the mechanistic, the object that can be analyzed, broken down into parts and assemblies, and held in the hand and examined, component by component.

“The heart, being essentially a sophisticated pump, is thus inherently attractive to the cardiologist, an object worthy of one’s entire career.”

Failing to take the known risk of depression seriously in these heart patients can have devastating consequences, as Dr. Fogoros warns. A 2007 study published in the European Journal of Cardiovascular Nursing on depression in women with coronary artery disease found that 74% of women diagnosed with post-cardiac event depression still had impaired physical and social functioning one year after their heart attack.* That impairment also meant that overall recovery, independence and quality of life was also impacted.

Depression is very common among those diagnosed with heart failure, affecting up to 40% of all such patients. As described at the 2015 European Society of Cardiology conference, depression as a direct result of hearing this diagnosis is associated with:

  • loss of motivation
  • loss of interest in everyday activities
  • lower quality of life
  • loss of confidence
  • sleep disturbances
  • change in appetite with corresponding weight change

So wouldn’t it just make sense for physicians to address these common depression symptoms instead of labelling such people non-compliant because they aren’t following doctor’s orders, taking their meds, eating healthy, exercising every day or bouncing back the way they should?

As reported in Harvard Health, post-operative depression following any type of surgery under general anaesthesia is in fact not uncommon, most likely occurring well after the crisis of surgery has ended and the patient is back at home or even at work. Dr. Bernard Vaccaro of Brigham & Women’s Hospital in Boston explained:

“When we’re healthy, we tend to think of our bodies as intact.

“Major surgery can shatter that image, and with it the concept of self-sustaining health. The feelings of mortality, of loss, and of vulnerability can be profound, and recognizing depression in surgery’s aftermath becomes very important.”

But if signs of depression hit immediately after surgery, he warns that doctors suspect hidden complications, perhaps a problem with anesthesia, an infection, or some other underlying cause – especially in older patients whose post-op delirium symptoms can appear subdued – much like depression.

But depression in heart patients – whether they have experienced a surgical procedure or not – has “flown under the radar for far too long”, concluded the study author, Dr. Colleen Norris. She added that doctors must look for symptoms of depression in all patients who are undergoing treatment for heart problems, but particularly in women.

We also know that the age of a heart patient may be an important factor here. For example, Dr. Susmita Mallik of Emory University School of Medicine reported in the Archives of Internal Medicine that younger women diagnosed with heart disease before the age of 60 are three times more likely to become depressed than male heart patients. Dr. Mallik observed:

“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.”

Cardiologists at Cleveland Clinic (widely considered the #1 heart institute in North America) describe temporary feelings of sadness as “common” following a cardiac event. They also warn that this sadness should gradually go away within a few weeks as people slowly resume normal routine and activities.

Sometimes, however, a depressed mood can be severe and accompanied by other symptoms (including withdrawal from activities, not responding when visiting with family and friends, increased negative thoughts and tearfulness – pretty well the textbook description of my own symptoms!) that persist every day for more than two weeks running. That’s when it’s time for heart patients to seek immediate help.

But I knew nothing about this kind of information at the time.

When those unexpected feelings of depression struck following my heart attack, I felt horribly overwhelmed, frightened and confused – and certainly too ashamed to tell anybody in my family. They’d already gone through so much because of my cardiac event; I couldn’t put any more on their plates.

On the seventh week of our 7-week Heart To Heart patient education classes, the guest speaker was the cardiac social worker at our local hospital, who talked openly about mental health issues common to those diagnosed with heart disease.  I recall feeling a glimmer of relief that evening just to finally realize that I was not alone – but this was over two months past my hospital discharge.

Why, I asked her after the class, isn’t this important topic right up front at the very beginning of their 7-week schedule of guest speakers addressing freshly diagnosed heart patients? 

Might scare people off, she replied. 

In effect, the stigma of a mental health diagnosis is so pervasive in our culture that not even our health care providers will warn us about what the statistics already clearly show. 

And when I shared with my (otherwise wonderful!) cardiologist my own experience with debilitating depression (after I’d started seeing a therapist), his reaction was to recheck my chart and observe:

“Well, of course, it could be the beta blockers you were taking…”

NO!  I replied. It was because I had just had a frickety-frackin’ HEART ATTACK!

Dr. Stephen Parker (a cardiac psychologist and – more importantly – a heart attack survivor himself) describes what he calls the “swirling emotions” he experienced after surviving a heart attack:

“Relief at survival — disbelief and anger that it happened — grief for everything that has and will be lost — gratitude to those who helped — extreme vulnerability in a previously safe world — fear of what the future might bring.

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

Sadly, emerging information from cardiologists is still barely mentioning the common experience of such deeply wounding events.

When I was asked to review the book Your Personal Guide: Angioplasty by cardiologist Dr. Allen Jeremias, I was dismayed to find virtually nothing on mental health issues.  Despite the fact that one of the book’s co-authors Dr. Susan Bartell is herself a psychologist, the psychosocial impact of being diagnosed with heart disease is virtually ignored here. How is that even possible?

In fact, I could find only one fleeting reference to this debilitating fallout common among so many heart patients, and that one reference is buried in a single paragraph in the “What About Sex?” section about halfway through the book.

Doctors, next time you’re seeing a freshly-diagnosed heart patient for a follow-up appointment, please remember that we’re more than just a major organ that’s successfully undergone a procedure.

It’s time to start paying attention to the real-life emotional, mental and psychological trauma embodied in the whole person sitting across from you.

© 2013 Carolyn Thomas Heart Sisters    www.myheartsisters


* Colleen M. Norris et al. “Depression Symptoms have a Greater Impact on the 1-Year Health-Related Quality of Life Outcomes of Women Post-Myocardial Infarction Compared to Men”. Eur J Cardiovasc Nurs June 2007 vol. 6 no. 2 92-98
** Susmita Mallik et al, “Depressive Symptoms After Acute Myocardial Infarction: Evidence for Highest Rates in Younger Women,” Archives of Internal Medicine 2006; 166: 876-883.
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39 Responses to “When are cardiologists going to start talking about depression?”

  1. Brenda August 5, 2016 at 6:28 pm #

    Oh my gosh. After 12 years, I finally don’t feel like a freak and alone.

    I was 44 when I had my first implant – stopped me dead in my tracks and I was used to going 140 miles an hour. I was discharged after 2 days with no idea what happened or what I should do. The “best” cardiologists didn’t tell me about heart therapy or clinics. I kept waiting for the other shoe to drop and end my life. That happened in 2012, but my life didn’t end, I had a v-fib episode in the hospital and had another implant. The depression just got deeper.

    Thank you so much for sharing all of this. Unless you have personally gone through something like this, where your life totally changes and you can’t go back to normal, you have no clue what it’s like.

    Thankfully I have a husband and family who are kind enough to care, if not totally understand.


    • Carolyn Thomas August 5, 2016 at 8:42 pm #

      Hello Brenda – you are neither a freak nor alone! Depression is widely recognized as a common – yet too often under-recognized – companion of heart disease. As cardiac psychologist Dr. Stephen Parker (himself a heart patient) likes to call cardiac diagnoses, they are deeply wounding events and can take a long time to recover from. And I think you are right: it’s almost impossible for those who haven’t experienced a catastrophic health crisis to really ‘get’ what we’re going through (yes, even our closest family members who care about us!) Please tell me that, although it’s long overdue, you are now seeking professional help through a therapist, pastor or some other trained professional to help you gain some perspective on this. You might also enjoy Dr. Wayne Sotile’s wonderful book Thriving With Heart Disease; it’s all about the psychosocial fallout following a cardiac event. Best of luck to you….


  2. Maguerita Zondagh July 1, 2016 at 12:44 pm #

    I am sorry to have to tell this, but I don’t buy the depression story any longer. My son (34) 2 years ago had QUINTUPLE bypass surgery. I didn’t even know there were that many arteries inside the chest. After a long operation on the heart lung machine (he did NOT have any heart attacks) very soon after convalescing at my home, I found that I had lost my son. He belongs to Mensa, is a very gifted person with a soft demeanour and yet I, his mom, became his target – nobody believes me. He sits all day in his room with the door closed and yet he says he’s busy with work. It’s a longer story than this, but to me personally I think the day I said good bye before they wheeled him in was the last day I saw my Michael. We have a disease called heterozygous familial hypercholesteroleamia and my younger son has the disease as well. I myself have given up on life altogether. I fully believe there’s something else going on and that this pump head syndrome issue is a fact!

    Liked by 1 person

    • Carolyn Thomas July 1, 2016 at 6:09 pm #

      Maguerita, I’m so sorry that both you and your son are being impacted like this. Feeling like you’ve “lost” your son is heartbreaking. Pump head has been a controversial subject even among cardiologists, but recent research does suggest that it is real, and can last a long time. Depression, however is very real, too, and can cause many of the same symptoms. No matter what we call it, something is happening that’s causing you severe distress.

      You may say that you don’t “buy” the depression story, but anybody who says they have “given up on life altogether” is suffering terribly from something that is treatable with help. Your son is an adult and no matter how much you love him, you cannot on your own force him or will him to behave differently. But you can do something to help yourself. Please call your physician to ask for that help for both you and your son – good luck to you.


  3. Sandra Robinson April 3, 2016 at 12:46 am #

    When I was on the table for my second stent surgery, doctor told me that the three stents he had placed six weeks earlier were already blocked. I asked if he could fix it and was assured that he could. I started to cry and was offered meds to relax me. I declined and said I would be OK. In my head though, I was thinking that maybe I was supposed to die. I am not suicidal, but can’t get that thought out of my head.

    I’ve had two years of hell with my health. Starting December 2014, renal failure and on peritoneal dialysis, diabetes, breast cancer, peritoneal infection and now cardiac problems.

    I’ve always had a positive outlook and before my second stent surgery, my attitude was…get my heart fixed and all I need to worry about is dialysis, and that will be easy.

    It’s only been three days and I don’t like my thoughts. I am planning to go to cardiac care for exercise and hopefully some counselling. I know this dark period I am going through will not last.


    • Carolyn Thomas April 3, 2016 at 5:29 am #

      Oh, Sandra. You indeed have had two years of hell with your health. I’m so sorry you’re going through this. No wonder you are feeling so bleak and overwhelmed by this most recent setback. I remember also feeling convinced that I would die in my sleep after being discharged from hospital (every night before bed, for example, I would clean my home so that if the paramedics -or worse, my grown children- had to come in and find my body the next morning, at least the place would look perfectly tidy).

      The only encouraging aspect here is your attitude: “I know this dark period will not last” – that alone will help you every step of the way. Meanwhile, please do not wait for your cardiac rehab program to start before seeking professional counseling. Get a referral from your GP for talk therapy to help you through this. And order a copy of Dr. Wayne Sotile’s excellent book Thriving With Heart Disease – it was a lifesaver for me. I’ve written many times about his Four Stages of Heart Illness here focused on the psychosocial fallout from a cardiac event. Best of luck to you….


  4. Greer Smith November 15, 2015 at 1:27 pm #

    I have experienced three major “Ventricular Tachycardia Storms” since June 2015, got an implanted defibrillator after the 1st, 3 months later went into all day VT storm getting shocked multiple times and then dying, to be brought back multiple times.

    Since the first event where I had to get 2 shocks in the ER, I have experienced depression, withdrawal from normal social events, and a very foggy sluggish thought process. Has anyone experienced these things, especially the mental fog?


    • Carolyn Thomas November 15, 2015 at 6:17 pm #

      What a truly awful experience you’ve had this past summer! No wonder you’re feeling this mental fog. It may not help you to be reminded, but you are still in very early days when you’re still getting your brain wrapped around what the heck has hit you, and when the mental health fallout following a health crisis is most expected. I can’t speak as an ICD/VTac patient, but I can tell you about an interesting study published in the Journal of Cardiopulmonary Rehabilitation and Prevention. It looked at levels of death anxiety, shock anxiety, general anxiety and marital adjustment of participating couples when one of the pair had an ICD implanted. Female ICD patients reported more anxiety related to both dying and being shocked than male patients did – perhaps because women actually did receive more shocks from their ICDs than men did, despite equivalent levels of medical severity. I wrote more about this here. I hope you will seek some professional counselling to help you during this time. Best of luck to you, Greer…


    • maryrossteele November 16, 2015 at 3:10 pm #

      As an ICD/VTach survivor with multiple shocks and dying from 4 years ago, I too have experienced some of the mental fog you describe.

      There are odd blank events, etc. that I have no recollection of – more in the first year than now but those blanks still exist. I try hard to remain positive, be thankful I am alive, and just chalk those moments up! One thing I do is exercise a lot at our local hospital’s cardiac rehab which helps relieve all that stress. Take it all day by day and look for those blessings each and every day!

      Mary in South Carolina

      Liked by 1 person

    • Clayton Owens May 9, 2016 at 7:53 pm #

      Yes I had my first heart attack in 2000, I was 32, defibrillator put in; in 2003 2 more heart attacks; 2005 another heart attack; 2007 put on blood thinner no more heart attacks but heart damage caused VT storm. I was in hospital when it happened; 2012 shocked 12 times in a row; yelled out kill me please then passed out; 5th shock since then; 2 ablation operations 9 hours – first one 6 hours, second I have not had any problems since but I am scared any time I feel any little thing inside or loud sudden noise outside.

      I work in the home inprovement trade; I have a 12 year old son and 17 year old daughter; money is tight. I worry all the time, one thing seems to help, jesus died for me the gift of god is eternal life through jesus Christ our lord romans6:23. I am come that they might have life and that they might have more abundantly john10:10 whosoever shall call upon the name of the lord shall be saved romans 10:13 for god so loved the world that he gave his only begotten son that who so ever believes in him shall live forever john 3:16

      I hope this helps; it helps keep my mind straight, its still hard every day prob still there the mental fog can wear you down; look forward not back; you lived thru it once; don’t put yourself thru it ever day; the weight of the past can be to heavy.


  5. Michelle January 1, 2015 at 11:41 pm #

    I had several heart attacks a month befor my 43rd birthday. I’m a single mom with a 11 year old child. I went to hospital the night I was having chest pain and next thing I knew, I was hooked up, told I’m fine, would just need some meds and I’ll be going home in the morning after some observation.

    I fell asleep in the hospital but the next thing I know, I was being woken up and told I’m being rushed to another hospital for heart surgery. Panic set in – I start asking questions but the nurses’ answers were you have to talk to your doctor. Once I got to the other hospital, again I started asking questions. I’m told to ask the doctor and brought into where where I asked where is the doctor? I have questions…

    When the doctor came in, I start asking questions, his only answer your questions will be answered after we get things going. Next thing I know he tells me everything is fixed, you’re going to be fine and leaves the room.

    I never did get my questions answered. When I asked the nurses in recovery, they said my heart doctor back in my hometown would be able to answer all the questions as soon as they transfer me back in the morning.

    I ended up having a stent put in the main left ventricle. I was on no prior medication at all and now I’m on cholesterol meds and blood thinners, and was recently put on blood sugar medicine for diabetes.

    My cardiologist is an amazing doctor back home. I know I have been feeling depressed and withdrawn. Even my child has to beg me to play with him. I do go to cardiac rehab through the hospital, but everybody’s 20 to 30 years older than myself and it makes it hard to integrate myself into the program and the discussion as I feel like an outcast being such a young female who suffered a heart attack in the last three months.

    The hardest thing for me is that I’ve always been the pillar of strength for everyone around me. My friends and family would always call upon me to help them pick up the pieces. And now I can barely pick up my son’s clothes on the floor.

    I know I need to speak to someone. I’m just very frustrated that no one in the medical field has brought to my attention that I would be going through an emotional roller coaster after what it happened. I am back to work but really don’t want to be there. I make every excuse to show up late or leave early and what I want to do is stay within my house. I don’t want to go out; however I do have a few days a month where I’m feeling a lot stronger emotionally but I still live with pains across my shoulders and arms and sit for hours on end, moping and crying.

    The one good thing that I did do when I left the hospital was Google and read up recovery rates on young women, what happens to women after heart attacks. I was aware that females in my age bracket are more likely to deal with depression after heart attack…but I’m stubborn and said it’s not going to happen to me . I think that’s the hardest part to swallow right now and that I do need more help than what I can do myself. I don’t want any more pills but I do thank you for your article and the research that went in to your writings.

    I do think every person who has a heart attack or heart surgery or heart issues should automatically be referred to a support group or counselor in their area to be monitored for depression. That’s one thing I hope that once I get past my emotional issues that I’m going to start pushing for within the Canadian medical system.



    • Carolyn Thomas January 2, 2015 at 6:24 am #

      Hi Michelle and thanks so much for sharing your own story here. What you’re describing is unfortunately very common – and not only with us heart patients, but with those who have survived any life-altering health crisis – and especially people like you (and me!) who always considered ourselves “pillars of strength” before our diagnoses. I absolutely agree with your observation that routine monitoring of all heart attack survivors should be automatic.

      It’s wonderful that you’re going to cardiac rehab! Keep it up and do NOT quit (try not to focus on the older participants – the exercise itself will help both your psychological and emotional recovery). Daily exercise (especially when you’re feeling depressed) is the VERY BEST thing you can do for yourself at this time – even if it’s just running up and down the stairs. The important thing is to put one foot in front of the other.

      Also, make an appointment to talk to a counsellor, a pastor, a peer-counselling service or other mental health resource in your community immediately. Your cardiac rehab coordinator may also have some suggestions. You might also like an online support community like WomenHeart where you will find thousands of other women in the same boat. I found this site to be very valuable in the early months following my own heart attack.

      Best of luck to you, Michelle…


    • Aida August 20, 2015 at 10:14 pm #

      Hi Michelle,

      Thank you for sharing your story and for being so honest about your feelings and situation. Your experience caught my attention because I agree with you that patients need to be prepared to handle these emotional changes and depression. I found this to be true when I brought my husband home from a mitral valve replacement and his mental state had been altered. I did not recognize him at times. I also did not know what to do.

      With that said, I have committed myself to learning as much as I can about helping people when faced with similar issues. Although I am not a counselor I am a trained and soon to be certified Wellness Coach through the Mayo Clinic. During my training I took the initiative to learn how wellness coaching might be a help to ones with heart disease. (EDITOR’S NOTE: Contact info deleted as this site does not allow soliciting my readers)


  6. Deserted September 22, 2014 at 7:20 am #

    (Edited for space):

    Went through it too. Almost 2 years ago, I had two Heart Surgeries on the same day, back to back. First was non-invasive Mitral Valve Prolapse Repair with regurgitation. Surgeon finished, everything went well, he checked me over over many many times he told me later, and everything looked good before he closed me. Right after he closed, my blood pressure dropped. So he quickly opened my side stitches to see what was going on and saw bright red blood. What he found was that the sutures on my heart broke open.

    They had to drain my lungs from filling up with blood. Also I had 2 mini stokes. I was in cardiac arrest, loaded up with all kinds of medications, and had several blood transfusions while back on the heart lung machine that I had just been taken off of. The surgeon later told my husband that he wasn’t sure if I was going to be brain dead. Cardiac arrest happened 2-3 times over the 7-8 weeks I was in the hospital. I was in bad shape and at risk of dying for a long time.

    I’m sorry this is so long but it was a long trail and a long journey to get to where I am now. It was your subject matter here that got my attention as you can guess by this story so far.

    Today, I still have thick wires that stick out of my chest and if I bang any thing against them accidentally it hurts.
    Even just yawning still hurts, and when I have to sneeze, I have to grab my chest and push.

    Still hurting like this is a constant reminder and depressing. The thought that this should have healed by now and it seems others don’t have that 2 years later, and I don’t know if it will ever go away.

    It didn’t take long after my surgeries for depression and fear to set in, being in a completely helpless state – a great sadness and emotional pain that felt very overwhelming, depressing and hopeless and for awhile this happened to me everyday at different times and I cried and cried from the depths of my soul from the toll this all takes still on me every day.

    Hospital staff never gave me a support person to come see me and help me. They knew I was depressed so they just put me on an antidepressant and that didn’t stop my feelings of pain and suffering and fear or crying. The doctors and surgeons and head nurses should be watching the patients and not just drugging them up till they can send them home with no emotional/mental referrals for help. Why no referral for psychological help? I didn’t know or even think on my own to ask for this help sadly.

    I came home from 3 months in cardiac rehab in the end of Feb 2013 and was so happy to be home. Yet sometimes I curled up in a ball and slept and cried and took care of my cat who was my love. I rose up very slowly to go do things. I laid on my couch everyday, and my husband cooked. I was so weak that after a shower I needed to lay down to rest and sleep.

    A couple weeks ago I found myself crying alone in my room 2 or 3 times a day and not wanting to talk to anyone about it anymore, because they think the same thing, it’s over, and just move on with your life, and look how far you’ve come, you have a lot to be thankful for.

    One of the worse things to say to someone going through this if they are sharing some emotional pain is something like: why don’t you just forget it and move on. Or the worst one: I don’t want to hear about it any more. That will shut the person down from letting you know when they’re hurting. Maybe they just need to express it and then they will get it out and feel better. They aren’t looking for you to have an answer to fix it because you can’t.

    If you do want to say anything, then just encourage them to try to do something they like to do to get their mind off it for even a while.

    Mine was quite a journey and I did have to take an early medical retirement from my job and that worked out well and my finances worked out well through this whole medical time I was out of work from my job and after I came home too.

    Well I hope something I shared here will help someone else going through this hard stuff because they don’t offer or even tell patients they can request help even while they are in the hospital. When something unexpected and traumatic happens, the patient/family don’t know to ask because they are dealing with a problem or trauma unexpectedly.

    Well thanks for reading my story and sharing my trauma and resulting depression I have had to battle through too. Say a prayer for me to stay up and to maybe still find the right person to go see to help with the weakened parts of my life that I have a real battle with that I need to overcome to function better and be happier because there are some things I would love to do if I could function right to be able to them.

    Thank you for your time and prayers sisters, you have mine.

    God bless you all on your journey.


    • Carolyn Thomas September 22, 2014 at 8:25 am #

      Dear Deserted – as you can see, I have significantly edited your comments yet it is still very long! The depression and anxiety you describe is not a surprise after what you have gone through. Your experience in feeling dismissed or ignored while trying to share your story with others is sadly very common for many of us. See: “Why We Keep Telling – and Re-Telling – Our Heart Attack Stories” The secret is to be very careful in choosing who you decide to disclose to: often our closest family members/friends are simply NOT the most appropriate audience – because they want and need us to be “normal” again. That’s where we need instead a trained psychological counselor, pastor or mental health professional.

      What I’m concerned about now, however, is that two years has passed since your two surgeries. While it seems that, unfortunately, nobody offered you emotional support/counselling during that time, you are now well aware of how helpful this support is, which means you could pick up the phone today to request a referral to ongoing talk therapy. I hope you will do this for the sake of both your physical and emotional help. Best of luck to you…


  7. Christie January 11, 2013 at 12:45 am #

    My 40-year old husband biked his way through a heart attack involving 100% blockage of the LAD on Jan. 2. We’re both in this weird “how did this happen?” questioning stage, and we’re definitely both sad at what could have happened, the life we had that now has to change, and the thought of what is more likely to happen now that he’s experienced one heart attack.

    I’m not sure exactly why I’m posting this as I have no real point. I can tell you that I find it incredibly difficult to fall asleep. I keep checking to make sure he’s breathing, as if he might expire quietly in the night as a result of said attack. And I’m deathly afraid of preparing a meal that’ll kill him because of the salt or bad fats.

    Might I inquire if you have any good cookbooks to recommend? We’ve already ordered a big AHA cookbook. Best wishes to you. We’re still working our way through this.


    • Carolyn Thomas January 11, 2013 at 6:20 am #

      Hi Christie – I’m so sorry to hear of your husband’s shocking experience. Welcome to the very exclusive club that nobody ever wanted to join.

      Your feelings of “hyper-vigilance” around him are very common. I wrote about that recently here. These feelings WILL wear off in time, but right now can feel overwhelming and exhausting. You might want to also read “How To Cope When Your Hubby Is The Heart Patient” which also has some links to some really helpful recommended books for women in your shoes, as well as some good advice on “Self-Care for the Caregiver”. Good luck to you!

      PS My very favourite cookbook: anything from Bonnie Stern’s “Heart Smart Cooking” series.


  8. Ember Branch January 6, 2013 at 2:24 am #

    Reblogged this on Ember Branch and commented:
    Take care of your second life.


  9. HibernationNow January 5, 2013 at 5:26 pm #

    When my father had a heart attack and then quadruple bypass surgery his heart surgeon (one of the best) did not care about his mental health. It wasn’t “his job” and that was made very clear.

    It’s like that in today’s medical care too. My Internist always refers me to “Specialists”; she stays within the narrow confines of her sinus infections and strep throat. The cardiologist and the cardiac surgeon viewed my dad as a number even though it was many years ago and it was a very risky procedure. When my father got severely depressed, he went to see a psychiatrist. I don’t think it ever occurred to him to broach his heart team.


    • Carolyn Thomas January 11, 2013 at 6:25 am #

      I think your Dad’s experience is not unusual! It’s an example of how fragmented each specialty can become (not involved in the “whole” person at all). Our family doctors can serve as the traffic cop here, but – given the known poor outcomes of depressed heart patients – cardiologists MUST be both aware of and pro-active in asking their patients about mental health issues.


      • Joanne McIntosh June 29, 2013 at 11:03 am #

        “I think your Dad’s experience is not unusual! It’s an example of how fragmented each specialty can become (not involved in the “whole” person at all).”

        This is so very true..and more often than not, it can result in the patients themselves feeling fragmented. How can we, as women especially, truly feel mentally/emotionally healthy after not only experiencing a total loss of control over our bodies..but also in the aftermath, to be consistently treated as if we are no longer “whole people”?


        • Carolyn Thomas June 29, 2013 at 11:38 am #

          Good question, Joanne. This fragmentation of care does indeed contribute to the associated fragmentation we can also feel as we try desperately to make sense out of what doesn’t make any sense. This is the “new normal” in which our doctors’ focus is now on our numbers, not on us a a whole person.


          • Joanne McIntosh June 29, 2013 at 5:48 pm #

            “Normal” is merely a setting on the washing machine, I think.

            But it does raise the question of just how much this impersonal, fragmented delivery of care actually contributes to post-event depression and subsequent follow-up care. Are we being systematically conditioned to focus on our physical well-being, one body-part at a time?


            • Carolyn Thomas June 29, 2013 at 6:38 pm #

              Joanne, I like how you think. There are so many theories on our post-event depression! Consider the lost practice of convalescence, for example. Or length of stay in hospital: decades ago, heart patients were kept in hospital for several days during which time they interacted with the dietician, the occupational therapist, the social worker and many physicians and nurses. By the time they were discharged, they’d actually started to get their brains wrapped around what the heck had just hit them. Not so anymore . . .


              • Joanne McIntosh June 29, 2013 at 8:01 pm #

                That’s very true. I’ve been a heart patient for 20 years now, and some of the “changes” I’ve seen in care delivery have shocked me…
                I also like the way you think, Carolyn. I’m so impressed with your blog/site. I have never seen such a comprehensive patient-oriented addressing of issues…and I’ve been looking for a long time. Kudos to you!


  10. granny annie January 4, 2013 at 5:29 am #

    The question determining whether we are depressed or not seems to be “Do you feel suicidal?”

    I did not so I was pronounced “not depressed” after my first heart attack. Thankfully my PCP took some time to give me a little questionnaire that asks more than that one question and discovered that I was most likely depressed. (Sadly a condition my spouse does not acknowledge as being real.)

    I began trying several medications without any good results until we hit on Lexapro 10mg and the results were amazing. Plus my PCP assured me this depression was common after a heart attack.

    My Cardiologist, to this day even after my second recent heart attack, has never asked me a thing about depression. My spouse to this day does not know I take Lexapro for “mood”.

    After this second attack my gynecologist discussed depression with me and supported my suggestion that I would increase my Lexapro dose to 15 mg. When I asked my Cardiologist what he thought about that, he simply responded “Whatever you think helps.”


    • Carolyn Thomas January 4, 2013 at 6:48 am #

      Hi Annie – sadly, your cardiologist’s response is all too common. Mental health issues are under-appreciated (not only by docs, but often by our family members, as in your case). Before my own experience with depression post-heart attack, I didn’t “get” it either. Not at all.


  11. Sherrie Bullard January 3, 2013 at 6:04 pm #

    I too share many of the other women’s experiences of depression after my heart attack.

    Though I tried to keep it to myself, thinking it would just go away in time, it really never did. Then, seven months after my heart attack, my husband died suddenly, so of course my depression became major.

    Thankfully, with the aid of medication, exercising, eating healthy, and support from friends and family has lessened my depression, but it never has completely healed me.

    Sometimes the depression is more painful than having a heart attack. I do feel that depression should be addressed to heart patients before discharge, and also would recommend it to the cardiac rehab nurses to address in their rehab classes.


    • Carolyn Thomas January 3, 2013 at 6:38 pm #

      “Sometimes the depression is more painful than having a heart attack”. Most people who haven’t experienced depression after a cardiac event might find this statement hard to understand. True for me, too, Sherrie. Thank you for taking the time to share your experience here, and my condolences to you on the sudden loss of your husband.


  12. Wanda January 3, 2013 at 5:02 pm #

    I think depression and anxiety are under treated. I have taken Wellbutrin and celexa for years with great results.

    Don’t tolerate your symptoms another day. See your primary care provider for assessment. Take care of all aspects of your life. It will make a big difference. Exercise, eat well, sleep 7 hours. Have supportive relationships. Don’t get overtired. Pay attention to your thoughts, they influence your mood and behavior. Be mindful of your blessings.


    • Carolyn Thomas January 3, 2013 at 5:07 pm #

      Good advice, Wanda – I particularly appreciated “Don’t tolerate your symptoms another day!” Being reluctant to seek professional help just makes the status quo seem more normalized – not good for heart patients.


  13. Mary January 3, 2013 at 9:29 am #

    There is so much food for discussion here, but I will keep my reply as brief as possible. You are, as usual, 1,000% right. But there is more. Depression is anger or sadness turned inward, layered with different forms of the self protection called denial.

    Whether it is an “actual” heart attack, or just daily chest pain that is recurrent and constant, treated or untreated, depression is a virtual given. I don’t know anybody who goes through this who isn’t profoundly distressed.

    Ultimately, this type of experience is a mortality threat, just as cancer is. All doctors have to do is take the playbook on cancer depression, and apply that to heart issues.

    But yes, there are differences. Those with heart issues may not be able to exercise, no matter how good it is for you. There may or may not be “a cure”. Life may not return to normal. But the center of this experience is that it is a deeply wounding mortality crisis.

    By definition, one’s body experience and one’s mortality awareness are now deeply linked, and it becomes a constant companion, because we are watchful for “signs” that things are not right with our heart. And, they aren’t ~ it is the new normal.

    We have written volumes about midlife crisis, mortality crises because we know it is psychologically unsettling. Aside from other daily living issues, any questions must be opened up and addressed that lie at the core of the distress: How do I feel about mortality? Am I ready for it? Do I believe/not believe in God? Why have these bad things happened to good people (me!)? And more, yet….

    It takes a deep therapist to recognize and travel on mortality journey with the respect it deserves. I used a therapy called EMDR, which was a good choice for me. It takes a deep therapist to accompany their patient on this very personal journey. The visit to this foreign and sometimes very feared place may pave the way back to living life with new and deeper eyes, new and unpredictable terms and renewed enthusiasm.

    * The film, The Way, highly recommended as a metaphorical experience ~ Buon Camino, pilgrims.


    • Carolyn Thomas January 3, 2013 at 3:41 pm #

      Oh, Mary. You have raised many interesting points here. Thanks for reminding all of us that mental health problems are associated with many cardiac issues – not just heart attack. Many patients living with heart failure, or with an implanted device like an ICD, or with serious arrhythmia diagnoses, or with a number of other cardiac conditions also report depression and anxiety. It’s the HEART we are talking about here, that is why! Even the most benign symptom can lurch us into an “Is this something? Is it nothing? Should I call 911?” frozen panic. Thanks also for your helpful recommendations to address this issue.


  14. Dr. Anne Stohrer January 3, 2013 at 8:33 am #

    Yes Yes Yes! I have had multiple conversations with providers since my quadruple bypass, and none of them has been willing to acknowledge the huge emotional toll of a cardiac event and the barbaric invasion of the body that is cardiac surgery. And when I have queried about support groups, I have been uniformly told that they don’t pay so they aren’t run. Or the current culture doesn’t support them. Or nobody wants to run them. Etc.

    When I was lying in my bed the first day out of intensive care, the cardiothoracic surgery fellow asked me how I was. I told him that I had just spent the worst night of my life. He tsked and said, “Oh, we’ll pull your Foley and your chest tube, that should make things better” and breezed out of the room. Little wonder I was in tears after that.

    I could go on and on. This is a really important topic that needs to be addressed by cardiothoracic services everywhere.


    • Carolyn Thomas January 3, 2013 at 3:30 pm #

      Hooo boy, your story of your first day out of the CCU is maddeningly common – and tragically representative of the inability/unwillingness of some health care professionals to address the psychosocial impact of a cardiac event. Thanks a lot, Dr. Anne.


  15. Rachel January 3, 2013 at 7:07 am #

    Hi Carolyn,

    I really enjoy your essays. In November I had open-heart surgery to replace my mitral valve and repair my tricuspid valve. I’ve had quite painful, debilitating depression since about three weeks post-op.

    Also, because I chose the mechanical valve due to being 42 years old, I am and will be on coumadin for the rest of my life. It’s affected my menstrual cycle quite a bit, and I am afraid of having dental work done, cutting myself et cetera, not to mention the weekly blood tests, and I had better never go without health insurance! This wasn’t discussed with me before the surgery or after. Really, I wish I had done more research pre-op.

    I’ve heard that the heart-lung machine and the anesthesia together somehow cause the post-op depression; of course I don’t know the exact cause, I just know that I am depressed. If it doesn’t go away soon with the positive lifestyle changes I’ve made, I’m definitely going to see a mental health professional. I talked with my cardiac surgeon (very nice man) and he didn’t quite know what to say.

    Apologies for the length, I just wanted to mention that post open-heart surgery is a possibility as well. I even read a New York Times article about this by googling “open heart surgery depression.”

    Thanks Carolyn!


    • Carolyn Thomas January 3, 2013 at 4:06 pm #

      Rachel, thank you for telling your story to us here. Please do not wait to see if your depression goes away: call today for an appointment to see a mental health professional. If nothing else, the very act of talking to a trained therapist who knows better than to tell you he doesn’t “quite know what to say” should feel better. Meanwhile, for some practical help, read “10 Non-Drug Ways To Treat Depression in Heart Patients”.

      Earlier studies have looked at depression in patients who suffered a heart attack or underwent open heart surgery as you did, but recent research also suggests serious depression is common in other heart patients, too. For example, a Danish study last March examined what effect depression might have on mortality in patients who had coronary stents implanted and found that patients who are depressed after stenting had significantly worse prognoses compared to patients who were not depressed. The heart-lung machine’s “pump head” is not the only culprit!


  16. Sandy January 3, 2013 at 6:37 am #

    Wow, you just described me to a tee. After three years my depression is no better. I still feel the same today as the moment my cardiologist said, “you had a heart attack”.

    I push myself everyday to keep going for my family but deep down inside I could care less about anything. I just want someone to understand how I feel instead of thinking I should be Miss Happy Happy and still do the things I use to do before the heart attack.

    Physically I am not the same person and don’t think I ever will be. Everyday life details are not important to me anymore. I see myself stepping further and further behind and no one understands. Even the nurses at rehab, which I have been to three times, don’t understand it. They don’t think depression is a part of it at all.

    I feel like I’m standing in the middle of a foggy field and no one can see me. I pray everyday I don’t have another heart attack because I will give up completely. I’m going to copy and send this article to my cardiologist, family doctor, rehab nurses, and director of my hospital and see if it opens any eyes.

    Thank you for writing this and letting these people know where I am at in my life.


    • Carolyn Thomas January 3, 2013 at 3:24 pm #

      Thanks so much for taking the time to share your own experience, Sandy. It’s so important that our doctors (and rehab nurses, and hospital administrators!) learn what it can actually be like for so many of us. Good luck to you.


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