Depression after a Heart Attack

Working Through it Is Critical to Future Health

(LifeWire) - Jim Harrison, a 56 year old who walked 30 miles a week, felt a sharp pain and then numbness in his left hand in November 2006. It was serious enough to send him to a hospital, but he was shocked at the diagnosis: heart attack (or myocardial infarction).

An even bigger surprise was the depression that followed.

For months, the Springfield, Ohio, bookkeeper stayed indoors, slept much of the day and experienced profound sadness. "I hadn't cried since my dad died in 1994," he recalls, "but I bet I cried three to four times a week during that time."

About 20% of people who have a heart attack experience depression, fear or anger for two to six months after. There are several possible explanations.

Facing one's own mortality can play a part. So can worry. Survivors worry about their families or about being able to return to work or have sex again. Grappling with the loss of control and the lingering trauma of an emergency medical situation can also cast a shadow.

"You call an ambulance. There's this loud noise racing through the streets. You land in a hospital, and five people descend on you, putting in IVs and hooking you up to a heart monitor that beeps," explains Dr. Nieca Goldberg, a New York City cardiologist.

Medications can also be to blame. For example, beta blockers, often given to recovering heart attack patients, can cause depression.

Recognizing the Symptoms

Depression is defined as having persistent feelings of sadness that prevent a person from enjoying formerly satisfying activities: work, sleep, sex, eating, hobbies or social interactions. Symptoms can include:

• Despair, hopelessness, irritability or anxiety
• Guilt, feeling worthless
• Low energy
• Diminished interest in activities
• Difficulty with decision-making, poor concentration
• Frequent crying
• Inability to sleep or excessive sleep
• Eating too much or poor appetite
• Physical complaints that are unresponsive to treatment
• Suicidal thoughts

Prolonged depression increases the risk of a subsequent heart attack. It actually contributes to atherosclerosis, the dangerous buildup of plaque in the arteries, according to the January 2008 Archives of General Psychiatry. In addition, depressed patients often lose interest in self-care.

"They're not likely to start the exercise programs that are necessary to prevent a second heart problem or even take their medicines or follow a heart healthy diet. Or they might drink too much or return to smoking," Goldberg says.

Depression Can Be Treated

The first step in treating depression is to seek medical help. Your doctor can evaluate the effects of your medications. A mental health professional can assess the severity of your symptoms and the role of family history or other factors.

Some patients find relief in talking with loved ones or through support groups. For many others, that's not enough. Their treatment often involves newer antidepressants like selective serotonin reuptake inhibitors (SSRIs) -- for example, Prozac (fluoxetine) -- or serotonin and norepinephrine reuptake inhibitors (SNRIs), such as Effexor (venlafaxine).

Medication side effects can include headache, nausea, insomnia, agitation, sexual difficulties and -- rarely -- suicidal thoughts. But these drugs don't interact with heart medications.

In fact, antidepressants -- especially SSRIs -- may lessen the chance of a subsequent heart attack, according to a study published in September 2007 by researchers at Columbia University College of Physicians and Surgeons.

If SSRIs and SNRIs don't work, older antidepressants -- like tricyclics or monoamine oxidase inhibitors (MAOIs) -- may be tried. MAOIs aren't a first choice because their interactions with foods can cause high blood pressure and increase the risk for stroke and heart attack.

St. John's wort, sometimes touted as an antidepressant, has been found to alleviate symptoms of mild depression. But the herb can also interfere with some medications for heart conditions, depression and certain cancers.

Psychotherapy or "talk therapy" is beneficial for mild to moderate depression, sometimes in conjunction with medications.

Harrison decided not to take medication or seek therapy but to get support from his wife and from heart attack survivors who'd experienced depression. He joined The Mended Hearts, which is affiliated with the American Heart Association and has dozens of chapters in cities across the United States.

Two years later, he feels like himself again.

"Doctors and nurses can only do so much," he says. "You need to talk with people who've been there."

Sources: