What’s a Normal Reaction to a Heart Event?
Feeling anxious about having a heart attack or even worrying about suddenly dying from heart problems is very common after a heart attack or heart surgery or sometimes even after a procedure such as an angioplasty. Some people may question whether they should return to work or change other aspects of their life in order to decrease stress. Most people, but not everybody, regain confidence about their ability to resume daily activities over the 3 or 4 weeks after a heart event. However, persistent symptoms of depression or anxiety after a heart attack or surgery happen to 1 in 5 persons. Speaking with your family doctor or cardiologist about these symptoms is a good first step.
What is Meant By “Depression”?
Although many people have sad or blue feelings in the days following a heart attack or heart surgery, these usually disappear within a week or two as more confidence comes about the future. However, some patients can develop a “clinical depression” or “major depression” similar to other medical illnesses which require diagnosis and treatment.
Symptoms of major depression include:
- Feeling down, depressed, or hopeless most days of the week for at least two weeks in a row
- Loss of interest or pleasure in doing things that were enjoyable before
- Poor appetite or over-eating
- Trouble falling asleep or sleeping too much
- Feeling tired all the time or having no energy
- Feeling bad about yourself such as thinking you are a burden to others
- Being fidgety and unable to sit still, or the opposite – moving and speaking slower than normal
- Having thoughts of wanting to die or wanting to end your life
Major depression can occur in the weeks or months before a heart attack, or happen right after a heart attack or heart surgery. People with a history of depression are at greater risk of developing another episode after a heart attack or heart surgery. It is important to seek help, because major depression rarely disappears without treatment and there are several effective treatments available. Also some medical conditions, like thyroid problems, can produce symptoms similar to those of depression, and your doctor may need to test for these conditions. Finally, recent research has shown that having major depression may increase the risk of later developing heart disease. In people who already have heart disease, major depression has also been shown to increase the risk of having further heart attacks or even dying from heart disease.
What is Meant By “Anxiety”?
Anxiety symptoms happen in most people around the time of a heart attack or heart surgery but usually decrease and disappear in the next week or two. However, in some people, anxiety symptoms can persist all day long and are associated with overwhelming worry about their heart condition. Some people develop severe anxiety symptoms as part of a major depression. Anxiety symptoms can also come as sudden “panic attacks” which last minutes or even longer, and cause a person to think they are having a heart attack or dying.
Symptoms of anxiety can include:
- A feeling of shakiness inside
- Hand tremors
- Rapid breathing or feeling short of breath
- Muscular tension
- Being fidgety or having to pace
- Feeling faint
- Numbness or tingling in the fingers or around the mouth
What Can Be Done About Depression and Anxiety?
There are effective treatments for depression and anxiety disorders. Specialized types of psychotherapy have been shown to be effective for treatment of depression or anxiety in patients with heart disease. Cognitive therapy helps a depressed person identify negative thoughts about themselves, their world and the future, and correct these thinking errors. Interpersonal therapy helps identify and correct problems in relationships with other people, including difficulties with grief, conflict, changing roles, or lack of supportive relationships. Medication to treat anxiety can include use of a benzodiazepine medication for a few days or weeks. Antidepressant medications can be used for longer periods of time to treat both anxiety and depression. Certain antidepressant medications are shown to be safe in patients with heart disease, but interactions with other heart drugs must be kept in mind. Discussions with your family doctor or cardiologist can help you decide on what types of treatment for depression or anxiety would be best for you. In some cases, your doctor may recommend help from a psychologist or psychiatrist to help you through this difficult time.