I have a friend who has a friend who’s been depressed, off and on, for years. During that time, my friend and I have done our fair share of eye-rolling whenever the subject of this person’s depression came up. We wondered why she just couldn’t pull up her socks and quit all this self-absorbed moping around.
Neither my friend nor I had ever had one nanosecond of actually experiencing clinical depression ourselves – which, of course, didn’t stop us from passing judgement.
Fast forward several years to the weeks and months following my heart attack.
I knew something was terribly wrong with me. I couldn’t seem to concentrate, couldn’t make even the simplest of decisions, couldn’t stop weeping over nothing, and, most distressing for an extroverted optimist, I was unable to find any pleasure in the many things that I used to enjoy.
It’s not that I felt sad (although I often did) but more that I just didn’t care. I wanted to pull the covers over my head and hide all day long. I slept in my clothes. I forgot about clean hair or basic hygiene. I just didn’t care how I looked or how I smelled.
As I described this awful state in my post, “The New Country Called Heart Disease“:
“I felt fatigued and anxious at the same time, convinced by ongoing chest pain and shortness of breath that a second heart attack must be imminent. I felt a cold, low-grade terror on a daily basis.
“And my worried family and friends could not and did not even begin to comprehend what was going on for me – because I could scarcely understand it myself. Sensing their distress, I tried to paste on my best PR smiley face around them so we could all pretend that everything was “normal” again. But making even minimal conversation felt so exhausting that it eventually seemed much easier to just avoid other people entirely.”
I didn’t know it at the time, but I was getting a firsthand remedial course in correcting those misconceptions about depression.
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. Situational depression is very common, it’s treatable and it’s usually temporary.
But depression is a dangerous condition if you’re a heart patient, because we know that depressed people are far less likely to take their cardiac meds as directed, exercise, eat healthy, show up for medical appointments or cardiac rehabilitation classes, or follow basic medical recommendations.
Read this list of myths and facts to test your own knowledge:
MYTH: Depression is hurtful, but not a major medical condition.
FACT: Depression isn’t simply a temporary case of “the blues.” It’s a common, serious medical condition that can disrupt one’s daily functioning. At the extreme, people with depression may harm themselves. Brain imaging research shows that the brains of people with depression may function differently than those of non-depressed people. In depressed people, brain areas that regulate mood, behaviour, thinking, appetite and sleep seem to function abnormally. Also, important brain chemicals called neurotransmitters appear to be out of balance.
MYTH: Only emotionally troubled people become depressed.
FACT: Depression affects people from all walks of life, not just people with previous emotional troubles. Depression can strike after the loss of a loved one, trauma, a catastrophic medical event like heart attack or stroke, and other stressful situations. Some estimates reveal that up to 65% of women will suffer situational depression following a heart attack.
MYTH: Being optimistic can cure depression.
FACT: Depression is debilitating. Most people with the disorder will require treatment to get better. Few can will themselves to get well through positive thinking (despite my former psychologist’s questionable advice to “sign up for an interesting class at the university!” to cure my depression). Depressed people may also need medication to normalize brain chemicals.
MYTH: Most people with depression seek help.
FACT: Fewer than 40% of the general public living with depression see a mental health professional. Even though up to 65% of heart attack survivors develop some degree of depression, we know that – alarmingly! – fewer than 10% of these are appropriately treated. Many depressed patients remain undiagnosed or under-treated. Some cases are tough to treat, but the vast majority of cases are highly treatable with appropriate counselling therapy or meds. The earlier treatment begins, the more effective it is. See also: 10 Non-Drug Ways to Treat Depression in Heart Patients
MYTH: Depression is most common in elderly people.
FACT: In fact, middle-aged people 40 to 59 have the highest rates of depression. Depression is not a normal part of aging. However, ill health, medication side effects, social isolation, and financial troubles can trigger depression in the elderly, who belong to a generation that often feels ashamed to admit to feelings of weakness, sadness or grief. But it’s crucial to seek help, no matter your age.
MYTH: Depression causes emotional symptoms only.
FACT: Depression does cause emotional symptoms such as anxiety, irritability, and hopelessness. But it can also mean physical symptoms such as chest pain, queasiness or nausea, dizziness or light-headedness, sleep problems, exhaustion, and changes in weight or appetite. It can also worsen back and joint pain or muscle aches.
MYTH: Talking about depression only makes it worse.
FACT: Different types of psychotherapy, or talk therapy, have been proven effective in treating depression. For example, cognitive behavioral therapy teaches people different or new ways of thinking to replace negative thoughts and behaviours that may contribute to depression.
Sources: Heart and Stroke Foundation, Mayo Clinic, Canadian Mental Health Association
And here are even more disturbing facts about depression in general. We know that women 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 often caring for both their own children and elderly parents, thus increasing stress levels which in turn can lead to depression.
Since hypothyroidism can also cause depression in women, this medical problem should also be be ruled out by a physician. In fact, the American Association of Clinical Endocrinologists issued a statement in 2002 that recommended: “The diagnosis of hypothyroidism must be considered in every patient with clinical depression.”
When the former Globe and Mail reporter Jan Wong wrote about her own journey with debilitating depression in the book Out of the Blue, she described the life lessons that depression had taught her:
“The big life lessons are that you can have 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: that family matters. Everything else is extra.”
I’m embarrassed now, looking back at my profound pre-heart attack ignorance of mental health issues in general, and depression following a cardiac event specifically. Had I known more about how common situational depression actually is for heart patients – had I been warned even before I left the hospital! – perhaps I wouldn’t have suffered needlessly for as long as I did before seeking professional help.
If you are now experiencing depression, find out how you can get help.
NOTE FROM CAROLYN: A version of this post was originally published here on Heart Sisters in August of 2009.
I wrote much more about the important subject of depression and heart disease in my book, “A Woman’s Guide to Living With Heart Disease” (Johns Hopkins University Press, November 2017)
Q: Have you experienced depression in the past following a cardiac event?
- 10 Non-Drug Ways to Treat Depression in Heart Patients
- When are Cardiologists Going to Start Talking about Depression?
- The New Country Called Heart Disease
- Depressing News about Depression and Women’s Heart Disease
- Does that Ache Signify Undiagnosed Depression?
- “I’m Not Depressed!” – And Other Ways We Deny the Stigma of Mental Illness After a Heart Attack