Mental Recovery

Is it normal to feel depressed after a heart attack or heart procedure?

About one in five people suffer from major depression after a heart attack, bypass surgery, or angioplasty. Some degree of depression occurs in up to a third of all heart attack survivors. Women generally experience more depressive symptoms than men after a heart attack or bypass surgery. People with additional illnesses – such as diabetes, kidney, or liver disease – who survive a heart attack are more likely to experience depression.

Symptoms of Depression

Your physician may not recognize signs of depression, so it’s important that you familiarize yourself with them. Some people experience only a few symptoms while others experience many.

Symptoms of Depression

National Institute of Mental Health

  • Persistent sad, anxious, or empty mood
  • Feelings of hopelessness, pessimism
  • Feelings of guilt, worthlessness, helplessness
  • Loss of interest or pleasure in hobbies and activities that were once enjoyed, including sex
  • Decreased energy, fatigue, being “slowed down”
  • Difficulty concentrating, remembering, making decisions
  • Insomnia, waking up early, or oversleeping
  • Loss of appetite and weight loss, or overeating and weight gain
  • Thoughts of death or suicide; suicide attempts
  • Restlessness, irritability
  • Persistent physical symptoms that do not respond to treatment, such as headaches, digestive disorders, and chronic pain

Can depression affect my recovery?

Many, but not all, studies have found that depression increases the risk of dying after a heart attack. In women, depression appears to increase the risk of dying from a heart-related cause within the first year of a heart attack. In a study of people who underwent bypass surgery, depression was a stronger predictor of lack of functional improvement for women than men. The effects of depression can also last a long time: depression one month after surgery is associated with the recurrence of chest pain up to 5 years later. If you’re depressed, you may also be less likely to take your medicine or make the lifestyle changes prescribed by your healthcare provider.

Is it normal to feel anxious after a heart attack or bypass surgery?

Anxiety is common after a heart attack or heart surgery; up to one third of heart patients experience anxiety. Anxiety levels are highest in the first 12 hours after a heart attack. Many studies have shown that anxiety is more common in women than men after a heart attack or bypass surgery. For most heart patients, levels of anxiety return to normal after hospital discharge. If you can’t shake your concerns, you may have an anxiety disorder. About half of anxious heart patients still experience symptoms up to 1 year after their heart attack.

Symptoms of Anxiety

Physicians do not usually check for anxiety so it can go undiagnosed in heart attack survivors. Because of this, you should familiarize yourself with the symptoms of anxiety. Some people experience only a few symptoms while others experience many.

Symptoms of Anxiety

National Institute of Mental Health

  • Unable to relax or concentrate
  • Easily startled
  • Fatigue
  • Headaches
  • Muscle tension and muscle aches
  • Trembling or twitching
  • Irritability
  • Sweating or hot flashes
  • Feeling lightheaded or out of breath
  • Nauseous
  • Going to the bathroom frequently
  • Trouble falling or staying asleep

Can anxiety affect my recovery?

Anxiety after a heart attack does not appear to increase your risk of dying, but one small study found that people with higher anxiety levels 48 hours after their heart attack were five times more likely to have heart rhythm and blood flow problems. Another study of heart attack patients found that anxiety did not increase the risk of dying from a heart-related cause after 1 year in women, but slightly increased the risk of dying for men with very high anxiety levels.

What if my anxiety symptoms are more severe?

Sometimes people who survive a heart attack or undergo bypass surgery suffer from a specific type of anxiety called post-traumatic stress disorder (PTSD). PTSD is a condition that develops after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened.

Symptoms of Post-Traumatic Stress Disorder

Symptoms of PTSD are more severe than the symptoms of general anxiety. PTSD is usually diagnosed if several of these symptoms persist for one month or more.

Symptoms of Post-Traumatic Stress Disorder

National Institute of Mental Health

  • Recurring memories of the heart attack
  • Recurring nightmares about the heart attack
  • Emotional distress when passing by hospitals, or on the anniversary of the attack
  • Emotional numbness
  • Sleep disturbance
  • Heightened vigilance – expecting the worst with every ache or pain
  • Irritability or outbursts of anger
  • Avoidance of reminders or situations that remind them of the heart attack

Mental Recovery – Coping with Depression & Anxiety

What kinds of treatment are available for depression and anxiety?

Treatments for depression and anxiety include several different forms of therapy from a variety of counselors. Antidepressant medication may be helpful if therapy does not work for you.

Does psychological counseling help heart patients?

Psychological counseling is a broad term that can include talk therapy, stress management, relaxation exercises, coping techniques, and, in some cases, the use of antidepressant medications. Psychological counseling may be included in a cardiac rehabilitation program or performed independently. Studies show that heart patients who undergo either type of psychological counseling have lower levels of depression and anxiety and a better quality of life.

Does psychological counseling as part of cardiac rehabilitation reduce the risk of dying?

Heart patients who underwent psychological counseling as part of cardiac rehabilitation programs have greater reductions in psychological distress, blood pressure, heart rate, and cholesterol levels than people who underwent cardiac rehabilitation without a counseling component. Some, but not all studies found that people who participated in cardiac rehabilitation with psychological counseling were less likely to die or experience future heart problems. This reduced risk of heart problems and death was not always seen in women and elderly patients.

Does independent psychological counseling reduce the risk of dying?

Counseling done outside of a cardiac rehabilitation program does not appear to provide the same benefits. In the largest study of psychological treatments, people treated with cognitive therapy (a more active form of therapy aimed at changing the way you think and associate behaviors) and/or antidepressants after a heart attack were just as likely to die or have another heart attack as people who did not receive psychological treatments. When the results were broken down by race and gender, psychological treatment slightly reduced the risk of heart attack and death in white men, but not in white women or minority men and women.

In studies of psychological counseling done outside of a cardiac rehabilitation program, women don’t seem to derive as much benefit as men do, possibly because the treatments are less likely to work in women. Two studies of heart patients found that women were less likely than men to see improvements in depression and anxiety after a counseling intervention. Montreal researchers found that the risk of dying from any cause was slightly higher for women who received counseling compared with those who did not. If the psychological treatment does not reduce your depression and anxiety, it is unlikely to reduce your risk of dying or having another heart attack. The Montreal study found that men and women who experienced reduced depression and anxiety after psychological counseling (i.e., the treatment worked) were less likely to die or be hospitalized for a heart-related cause than men and women in whom the treatment failed.

How important is emotional support from family and friends?

Social ties and emotional support from friends and family are important during the recovery process. Social ties can include a spouse, close family members, and friends, as well as participation in group activities (social gatherings, religious organizations, etc.). Socially isolated heart attack survivors are four times more likely to die than survivors with social ties. Heart problems, such as chest pain ( angina) or another heart attack, also occur more often in isolated individuals. Emotional support from friends and family helps prevent depression, which in turn can reduce your risk of dying. It’s important to discuss your fears and concerns with your family members because people who suppress their feelings tend to do worse over time.

How can I cope with the reactions of my friends and family to my illness?

It’s very common for your family and friends to experience anxiety, depression, and fear after you have a heart attack or heart procedure. Studies of people who had a heart attack, angioplasty, or bypass surgery found higher levels of anxiety and depression in the spouses than the patients. After a heart attack or heart procedure, you may feel that you are getting well, but close friends and relatives may be troubled by what has happened to you. Your spouse may feel that they’re not getting enough support from healthcare providers, which can be both upsetting and frustrating. It’s possible that your spouse’s stress could delay your recovery.

Sometimes the reaction of your friends, children, or significant other may manifest as denial of the severity of your illness or even anger. This negative reaction may be a coping mechanism used to deal with feelings of fear. Your family members and friends may be afraid that you’ll have another heart attack, or die. It may ease their fears to know that there are steps you can take to reduce your risk of future heart problems, such as taking your medicine as prescribed, eating healthier foods, and getting more exercise.

They may also be reassured to know that there are things they can do to help you in the event of a heart attack. Encourage them to become informed about heart disease. They should be familiar with heart attack symptoms and what to do if you experience them. It may also be helpful if they learned cardiopulmonary resuscitation, or CPR. Courses are usually offered at local hospitals, fire and rescue departments, or Red Cross chapters.

How can I join a support group?

If you had a heart attack or have been diagnosed with heart disease, you may wish to join a support group of other women with heart disease to meet people who understand your specific fears, sadness, and worries. To find a support group, check with your local hospitals. WomenHeart, the National Coalition for Women with Heart Disease, runs free support networks with many locations all across the country. You can also try The Mended Hearts, Inc., which you can join for a small fee.

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