"A real pity party," recalls Lovell, now 54. "I felt like, just leave me alone and let me rot and die."
Lovell's depression is typical of what many bypass patients experience after leaving the hospital, says Dr. Nieca Goldberg, a cardiologist and New York University associate professor.
"What triggers this is people feel they don't have control over their situation," Goldberg says.
A Range of Emotions
Heart bypass surgery is a major, open-heart operation that involves replacing clogged arteries with clean ones taken from elsewhere in the body. It may follow a heart attack or may be preventative. In either case, it's common to experience any or all of these emotions after leaving the hospital:
- Fear: Being afraid of what lies ahead, especially concerning your health
- Anxiety: Sleeplessness, feelings of nervousness, tension
- Depression: Sadness, low energy
- Loneliness: Feeling no one understands what you're going through
- Anger: Losing your temper, negative feelings for those around you
In patients whose heart attack precipitated their surgery, these feelings can be set off by the trauma of their medical emergency. In all patients who felt fine until they discovered they needed a heart bypass, the shock of suddenly dealing with health problems can be overwhelming.
Medication such as beta blockers -- often prescribed for heart patients -- can cause depression, and researchers are investigating whether anesthesia may be a culprit as well.
Some people also feel their memory is not as good after the surgery.
If symptoms continue every day for two weeks or more, it's time to seek help from your primary care doctor, cardiologist or a mental health professional.
Climbing Back Up
To lift her spirits, Lovell's doctor prescribed the anti-depressant escitalopram (Lexapro), a selective serotonin reuptake inhibitor (SSRI). Although it can take 4 to 6 weeks to achieve the full effect, Lovell felt better almost immediately.
"The biggest thing is to admit is that you can't always do it by yourself," she says. "It's OK to say, 'I need help.'"
Side effects of SSRIs can include nausea, insomnia, fatigue and low libido, but Lovell has experienced none of those.
Going to cardiac rehab -- where participants are screened for depression -- is one of the best ways to ensure emotional as well as physical recovery after survery. It's an underutilized program, Goldberg says, with only about 15% of eligible patients attending, mostly because doctors fail to recommend it.
Finding a support group is also helpful to many who've undergone heart bypass surgery. It's critical to do all you can to conquer negative post-surgery feelings -- especially anxiety and depression -- because they may actually exacerbate atherosclerosis, or plaque buildup in the arteries. Also, patients who feel good emotionally are more likely to abstain from smoking, to exercise and take their medicines.
"Everyone is focused on taking care of the plumbing and giving the medications to prevent a second bypass or second heart attack," Goldberg says. "Now we need to focus more on the quality-of-life issues."
Sources:
"Coping With Feelings." AmericanHeart.org. 13 Sep. 2007. American Heart Association. 19 Sep. 2008 <http://www.americanheart.org/presenter.jhtml?identifier=3047697>.
Debbie Lovell. Phone Interview. 15 Sep. 2008.
de Jonge, Peter, et al. "Only Incident Depressive Episodes After Myocardial Infarction Are Associated With New Cardiovascular Events ." Journal of the American College of Cardiology 2006.48 (2006): 2204-2208. 23 Sep. 2008 <http://content.onlinejacc.org/cgi/content/abstract/48/11/2204>.
Nieca Goldberg, MD. Phone Interview. 25 Aug. 2008.
"Services We Provide/Emotions." ClevelandClinic.org. 2008. Cleveland Clinic. 19 Sep. 2008 <http://my.clevelandclinic.org/heart/disorders/recovery_ohs.aspx>.
Frasure-Smith, Nancy, et al. "Depression and Anxiety as Predictors of 2-Year Cardiac Events in Patients With Stable Coronary Artery Disease." Archives of General Psychiatry 65.1 (2008): 62-71. 16 Sep. 2008 <http://archpsyc.ama-assn.org/cgi/gca?allch=&SEARCHID=1&FULLTEXT=heart+attack+depression&FIRSTINDEX=0&hits=10&RESULTFORMAT=&gca=archpsyc%3B64%2F9%2F1025&gca=archpsyc%3B63%2F3%2F283&gca=archpsyc%3B60%2F6%2F627&gca=archpsyc%3B65%2F1%2F62&gca=archpsyc%3B55%2F7%2F580&gca=archpsyc%3B62%2F7%2F711&allchb=#65/1/62>.
