by Carolyn Thomas ♥ @HeartSisters
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 “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 – and 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: I wrote much more about becoming a patient in my book, A Woman’s Guide to Living with Heart Disease . You can ask for it at your local library or favourite 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 code HTWN to save 30% off the list price).
Q: Have you experienced new-onset depression following a cardiac event?
See also:
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
.
Heart Sisters 
I had two heart attacks within four days. I managed to persuade my husband and myself that the first one couldn’t possibly be a heart attack. I had read a lot of stuff about how different women’s heart attacks were, often only mild symptoms etc.
This one caused absolutely the worst pain I had ever experienced– in my jaw, arms, back and chest (I have had two children and peritonitis after a burst appendix so I had some experience of pain.) I was getting used to using a walker because of balance problems, so I decided these were exceptionally severe muscle pains, moaned and whimpered as quietly as I could and kept popping Tylenol extra-strength for arthritis.
After a couple of hours, the pain stopped. This was a Thursday. Friday I went to a wedding, Sunday I went to church, and Monday morning I woke up with the same pain. This time we went to the hospital. It was a heart attack. I had a stent, and am now in a cardiac rehabilitation program.
I have had bouts of clinical depression (genetic–runs in my family) since my teens, and have been seeing an excellent psychiatrist for years. Saw him the other day–am definitely not depressed, but am terribly weepy. Unpredictable bursting into tears–terribly embarrassing. What’s going on?
LikeLiked by 1 person
Oh my goodness, Judith! I can relate (I too have popped out two children the old-fashioned way, and I once spent a month in hospital following a ruptured appendix and peritonitis!) Which is to say: you and I know our pain!
It’s interesting to me that women so often tend to dismiss cardiac symptoms if they seem different from those of the infamous Hollywood Heart Attack, but they also tend to dismiss clearly obvious symptoms just as you did. You are lucky to be alive. In answer to your question, “unpredictable bursting into tears” is very commonly seen in the situational depression that’s experienced by heart attack survivors. As Dr. Stephen Parker, an Alaska cardiac psychologist (and himself a heart attack survivor) once wrote:
“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 damned good reasons to feel anxious and depressed. A heart attack is a deeply wounding event, and it is wound that takes a long time to recover from, whatever the treatment.”
Best to stop wondering whether or not your weepy feelings are or are not caused by depression. They are what they are, those “labile” emotions right at the surface, ready to erupt when you least expect them to. You have earned the right to experience them as a heart attack survivor. Best of luck to you…
LikeLike
Excellent and informative post, as always. Having had issues with depression in the past, I fully expected to have to deal with the post-cardiac form of it following my surgery. While I did experience isolated incidents of totally losing it (I remember one time at the end of a long day I just broke down and started babbling things like “I want my heart back”), I feel extremely lucky to be able to say that I don’t think I ever experienced symptoms for more than a day or two at a time.
I did go through a rough patch lasting about two to three months and getting worse around the time of my one-year surgery anniversary. Is that common, by any chance, or is it more likely that a myriad of personal factors specific to my life in particular triggered that instead?
LikeLiked by 1 person
Hello Kim – your experience leading up to your “heartiversary” is not uncommon. Some of my readers have told me that they felt like this annual milestone seemed to trigger traumatic reminders of the cardiac event itself, while others feel an odd sense of relief once they have actually made it to this milestone. It’s impossible to tell if it’s the date circled on the calendar or, as you say, just personal factors going on in life that can impact these “rough patches”.
LikeLiked by 1 person
Ah, that’s good to know. There were other factors going on for me as well, but I’m pretty sure the heart of it (haha) was the anniversary. Especially because I was determined that it was going to be a good day — I think I was trying to prove to myself how far I’ve come — and it just so happened that the entire week went… well, let’s just say it was an extremely disappointing seven days or so, the worst of which was the anniversary itself. So in retrospect, I guess it shouldn’t have been surprising where my emotional state wound up.
Anyway, thanks. It’s reassuring to know I’m not the only one who didn’t quite feel like celebrating when the big day came.
LikeLiked by 1 person
You are definitely not alone! What’s that famous quotation about “life is what happens when we’re busy making other plans!”?
LikeLike
Thank you so much for this article. I belong to a women’s group and one of our friends is severely depressed and pulled away from all of us. I sent this article to each person in our group so they can better understand what she is going through. You are so right, you just don’t pull yourself up. Many have no idea what she is going through.
Thank you for putting it in simpler terms what is happening to our friend.
Michelle
LikeLiked by 1 person
Michelle, you are an awesome friend! If only more people were like you! Your friend is not only struggling with depression, but such struggles mean she is also likely feeling embarrassed and ashamed because of the widespread stigma of mental illness. Best of luck to you and your women’s group members…
LikeLike
I did not have a heart attack, but had symptoms which led to open heart surgery (aortic valve replacement). Surgery went well and I did all the “right” things post op.
Weeks later things weren’t so good and I felt totally blind sided by my complications. My confidence left me and I was scared, so scared. I plunged into such a depression. It was just as you describe… I had no motivation to do anything. I gave up. What was the point? I won’t go into all the ways it hit me except to say how horrible it was. I could not sleep,so there was no temp relief from this hollow feeling. I have been sad before and even mildly depressed, but nothing like this… nothing.
Med changes eventually helped as did meditation and exercise. There were times that I thought my lungs were filling up again and that I was again in heart failure. I was waiting for that proverbial other shoe to drop. I would dig out the breathing machine from the hospital and check my lung power. I dreaded my BP testing.
Eventually I started to believe I just might survive! Thank goodness for a supportive, patient husband, thank goodness for your wonderful Heart to Heart classes. I learned how to deal with setbacks. I learned how to deal with stress. I will never stop learning and I can’t thank you enough for your part in my recovery
LikeLiked by 1 person
Hi Penny and thanks so much for sharing your own compelling experience here, and also for your kind words. I’m glad you mentioned both meditation and exercise – two important (and no-cost) ways to help address situational depression. The turning point seems to be when we are able to do something – ANYTHING! – even when we don’t want to, and when we can finally say, as you did: “I started to believe I just might survive!” Congratulations – You made it!!
LikeLike
Carolyn, I had severe depression during the year following my heart attack and surgery. I thought I was coping and making rational decisions. Apparently, I was not. It ended up in divorce for 5 years. We came back together after I grew up and faced my life as a whole.
We are not always told what to expect and depression is one of the “biggies”. Life is good and I am one happy, contributing lady.
LikeLiked by 1 person
Hi Sharen – you are so right! If only all cardiac personnel were instructed to warn every heart patient before hospital discharge about how prevalent depression is so we wouldn’t feel so blind-sided if/when it strikes. Your own story is an excellent cautionary tale, i.e. try not to make life-changing decisions when in the throes of post-heart attack depression! 😉 So glad you were able to reunite with your hubby. Brava!!
LikeLike
I am so fortunate to have a family doctor that recognized what was happening to me. I was very depressed after my heart attack but I didn’t realize that was what was wrong. We decided against meds, but he had me come in regularly to help me through it. Once I was able to talk about what was wrong, I found additional support in my Cardiac Therapist.
I have so much sympathy now for people with depression as I have lived it.
LikeLiked by 1 person
Lucky you! Having a supportive family doc is SO important. And you are right – nothing helps develop empathy better than suffering what others have suffered. Best of luck to you…
LikeLike
I’m not sure I truly experienced clinical depression after my heart attack, but I sure experienced anger and resentment “big time” – especially around the dietary changes required in the wake of it, specifically the reduced/no salt prescriptions thrust at me and the wholesale revision of all my home cooking that was required.
I was also very scared – and like you imagined every little twinge in my chest as the onset – perhaps – of yet another attack. This is the wake of cracked ribs, due to CPR, led to sleep disturbances for quite awhile, until the ribs healed.
Fortunately, I had very good support in my husband and the adult son, who first administered the CPR, so wasn’t alone, when I came home from hospital, but I’m afraid I wasn’t very grateful for their company. Instead, I’m ashamed to say, I took out all my frustrations on my nearest and dearest, who bore it all quietly for awhile – and then sat me down and read me the riot act, i.e. “you’re being very self-indulgent. The reduced salt isn’t all that bad – we’re eating it! Get over yourself!” That helped – and I haven’t looked back.
However, I did seem to need to rehearse the story of the attack over and over for awhile – and I still ask questions from time to time about the period when I was unconscious, just after the cardiac arrest and during the induced coma, I experienced in hospital.
Just wondering if anger was/is part of depression? Doesn’t sound like it, but who knows? My husband’s theory is that all that rage, directed at dietary changes, allowed me to vent about “the injustice” of what happened – and then get on with adjusting to it.
What do you think? (You should know that I’m not usually an angry person. And that I eventually made an excellent recovery and now dutifully exercise, take my medications as prescribed and eat/cook sensibly – without all the histrionics.)
LikeLiked by 1 person
Thanks for sharing your experience here, Judy. So many good points! I think your hubby might be on to something with his misdirected rage theory: I had a similar experience a few weeks after my own heart attack. I marched around the apartment one day gathering up all the bouquets of flowers and get-well cards that had been arriving – and trashed the lot of them. I was annoyed by the appearance that some kind of sick person lived here! Trouble is, of course, it didn’t work and my ongoing symptoms continued. Cardiac psychologist Dr. Stephen Parker (himself a heart attack survivor) once observed: “A heart attack is a deeply wounding event” – so no wonder we respond the way we do.
Good luck with minimizing the histrionics!
PS Forgot to suggest this article about anger and heart disease: “When a Serious Diagnosis Makes You Feel Mad as Hell”
LikeLike
Carolyn and Judy,
I always say that post heart attack, I was “mad as hell and not going to take it anymore” to quote Peter Finch’s character in the movie Network. I was so angry. Why me? I was relatively fit, only about 10 lbs above my ideal weight, ate sensibly and didn’t smoke. I would look at obese people eating fast food and smoking and I’m ashamed to say that I thought, why me and not them!?
I didn’t understand that anger is a symptom of depression and finally gave into my PCP’s suggestion of anti-depressants. That and some very good talk therapy really helped.
Of course, we always wait for the other shoe to drop but now I know that when that feeling comes over me, it won’t last.
I do believe in listening to my body and these feelings carefully, when it was coming on last spring (that feeling of impending doom), it turned out that I had another major blockage that required a stent.
LikeLiked by 1 person
Hi Eve – I think that “why me?” question is almost inevitable after a traumatic event. Trusting that feeling bad won’t last is a learned skill! It’s why meditation and being “in the moment” can help so much. You’re also describing an important difference between those “impending doom” feelings: “this won’t last” vs “this just might be something serious and I need to pay attention!” Nice to hear from you today…
LikeLike
Hi Carolyn & Judy:
Carolyn, you always manage to touch my issues each time I read your blog.
Judy, after my bypass surgery, I kept telling people I knew I didn’t get a new heart but my personality changed. I’m a social worker & could listen & hear both sides of an issue with understanding. Bam! That changed after bypass; I had no patience with anyone, apparently so plain spoken, people were shocked. After reading side effects on medication, I
found deeply buried on side effects of statins, “irritability, short tempered, anger”.
I also have the attitude of “so what”. I have no energy & continuous fatigue. I have fibromyalgia & CFS so it’s difficult to know which is the cause.
Good luck! Thanks for all your work, Carolyn. You literally made me feel not so alone anymore.
Pam
LikeLiked by 1 person
Hello Pam – you have touched on an under-appreciated element of this kind of depression: the disconcerting change in our very personality. If you go from being this kind of person to being a very different kind of person, then who the heck ARE you!? You might be interested in reading Dr. Barbara Keddy’s work, Women and Fibromyalgia. Three years ago, she had a heart attack, and often mentions the question you have, too: is this fibro or is it my heart? I’ve quoted her writing often here because, although these are of course different diagnoses, the similarities with heart disease are striking. For example: Could ‘Goodism’ and Self-Sacrifice be Linked to Women’s Heart Disease Outcomes?
Good luck to you…
LikeLiked by 1 person
I appreciate everyone who shared their experiences. There are so many things that I read that made me think, “Oh, me too!”
I so resent having to reduce the sodium in my diet! I love salty foods, and in the past, I could eat them and still have a good blood pressure. Now…it takes me so long to grocery shop because I have to read labels — and there is so much salt in everything! Skim milk, Cheerios, Oreos! Who knew? Yes, I’m trying other spices and seasonings for food — but I miss the salt! Food is just so tasteless without it. I love soup — and any soup I find is basically salt water.
I resent that I have to think about this, that I can’t eat what I want, and that I have to take all the medication that I do. I see so many people who are obese, smoke, eat lots of junk food — and it’s not that I would ever wish a heart attack on anyone — but I can’t help thinking sometimes, “Why me, and not them?”
I just feel cranky and without patience, and it’s hard to talk about these things with anyone. I have a cousin who had a massive stroke at 59, and is in a wheelchair. I have diabetic friends and relatives who certainly face more serious dietary restrictions than I do. If I talk about this, other people might say things like, “Other people have it worse than you do,” and “You survived, without damage to your heart — you should be thankful for that.”
Look, I KNOW that other people have it worse, and that it could have been much worse for me than it was…. I AM thankful that I survived without permanent damage to my heart. I realize that people have to do harder things than reduce the sodium in their diet. It’s just, I can’t help how I feel and sermons on gratitude and perspective make me feel worse, not better.
I’m sorry that the ladies who posted here are feeling like this too….I’m sorry that any of us have to go through this….but it does help to know that I’m not the only one.
LikeLiked by 1 person
You’re most definitely NOT the only one, Susan. What you’re describing is actually common. Feeling cranky or impatient are often just distractions as we slowly try to make sense out of something that makes no sense. I remember marching around my apartment one day after my own heart attack and gathering up all the flowers and get-well cards and trashing the whole lot! I felt so annoyed that it looked like some kind of sick person lived here! Read this post about feeling “mad as hell” and see if you can relate. Meanwhile, you are smart to refrain from complaining to friends/family about things like salt restrictions; instead, consider making an appointment to talk to a counsellor, pastor or therapist to help you get to that “what is, is” stage – much healthier for your heart than being upset at your Cheerios!
LikeLike