Belonging Is an Important Aspect of Post-Heart Attack Care
A heart attack is terrifying. And even with great medical care, the flurry of emotions that go with facing your mortality can really wreak havoc with mental health.
And yet, studies have found that very few heart disease patients are ever screened and treated for depression — something experts are trying to change.
People hospitalized for a heart attack or chest pain develop major depression at a rate four times the general population, the American Heart Association says. Up to half of those who have heart bypass surgery become depressed, and one in three stroke survivors.
“Heart disease and depression are closely linked,” says Matthew Dickson, M.D., a cardiologist and physician on the medical staff at Texas Health Rockwall. “This has been examined in detail with people who have suffered a heart attack.”
Dickson adds that major depression is at least three times more likely to occur in patients after a heart attack than those who have not experienced a heart attack, and that minor depression after a heart attack is even more likely.
“Not only does this detract from the quality of life, which itself is important, but it also makes further heart attacks or death more likely in these individuals,” he adds. “The increased risk of heart attacks or death may be due to several factors, like not taking medications, continuing unhealthy behaviors such as smoking or physical inactivity, and having more stress hormones in the body.”
Beginning in 2008, the American Heart Association began encouraging cardiologists to screen all heart attack patients for depression—and even provided a short questionnaire. But 10 years later, studies show that few doctors follow this advice.
Experts agree that a cardiac rehab program that treats the whole patient can make a difference in the incidence of depression, as well.
“A cardiac rehab program can help with recovery after a heart attack for many different reasons,” Dickson says. “One reason is that with the increased aerobic activity there is a reduction in depression symptoms in many patients.
“The cardiac rehab program can also help make sure you are taking your medications correctly, offer you help in stopping smoking, help you get your blood pressure under control, help you to eat a healthy diet, and help you reduce your stress levels.”
The Texas Health family of hospitals offers two cardiac rehab programs: a traditional program and a more intensive program based on the Dr. Ornish Program for Reversing Heart Disease™ and Lifestyle Medicine approach.
The intensive cardiac rehab program participants attend two four-hour sessions per week for nine weeks. Each session includes equal time devoted to four key elements: exercise, nutrition, group support and stress management.
That group support and stress management play into the Blue Zone tenets adopted by Texas Health as well. Group support gives patients the opportunity to express fears, and to realize that others have the same thoughts, giving a sense of finding a tribe.
“Having a heart attack or stroke is a life-changing event,” Dickson says. “It can make you reexamine your mortality, change your ability to perform daily activities, require that you take new medications, or make you feel afraid of your risk for more health problems in the future.
“I think that it is important for people to remember when these thoughts come to mind that by taking charge of your health you stand a real chance at increasing both the quality and quantity of your remaining life.”
So, what can a patient—or their loved ones—do if they think depression is a factor?
“If you think that you are suffering from depression after a heart attack, the first step is to accept that your mental health is closely tied to your physical health and that both may require treatment for the best possible results,” Dickson says. “Then it is important to seek assistance in treating the depression so that you can feel better and possibly even live longer.
“Broadly speaking, this treatment typically involves a combination of medications and counseling,” he adds. “There are several different approaches to therapy, and as always it is important to discuss with your doctor any personal goals and preferences that you may have.”
Heart disease remains the number one cause of death for both men and women, yet there are many things that you can do to fight these odds, says Dickson.
“The most effective strategy to help you will depend on your specific situation, and will require honest conversations between you and your doctor.”