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Why is depression so common in cardiac patients?
Depression after both heart attacks and bypass surgery appears to be increasing in frequency. In the opinion of some, this increase is directly related to the short hospital stays now in vogue after major cardiac events.
In the old days after a heart attack or bypass surgery, patients would have 10-14 days in the hospital to assimilate their new reality, to accept their new status as cardiac patients, and to digest what it means to them, their families and their lifestyles. In many cases they would have received repeated instructions from medical personnel about their heart condition, and what they should be doing to improve their odds of symptom-free long-term survival. And by the time they were sent home, many of them would have begun to regain a legitimate sense of control over their own fates.
Today, both the acute treatment of heart attacks and the techniques of bypass surgery have vastly improved, and the odds of surviving heart attacks and bypass surgery are much better than they were a mere decade or two ago. But now, patients are tossed out of the hospital and onto the street the moment the acute phase of their condition has passed. They are released back into the world suddenly, with a brutal new sense of their own fragile mortality, and an instruction sheet listing 14 drastic changes they must make immediately in their lifestyles (stop smoking; lose 40 pounds; get plenty of exercise but don’t shovel snow; adopt a radical new diet; take these pills; etc.) if they want any hope of living long enough to see their savings bonds mature.
While it hasn’t been proven that this rapid-discharge scenario is the cause of the growing problem of “cardiac depression,” it seems likely that it isn’t helping much.
In any case, depression has become very frequent after both bypass surgery and heart attacks, and when it occurs the patient’s risk both of recurrent cardiac events and of death is greatly increased. The doctor’s failure to recognize and treat this depression can be a grave error.
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