Depression and heart disease: A two-way street

Depression and heart disease: A two-way street

From Harvard Health Publishing

All people have days when they feel sad, gloomy, or down in the dumps. But if those feelings last for weeks and you gradually stop feeling hopeful or happy about anything in your life, you may have depression. Like heart disease, depression is common, so it’s not unusual to have both conditions together. In fact, depression is about twice as likely to occur in people with heart disease compared with the general population. And people with depression face a heightened risk of heart disease.

“It’s really important for people to be aware of this link and to get treatment for depression because it can be very debilitating,” says Dr. Christopher Celano, a psychiatrist at the Cardiac Psychiatry Research Program at Harvard-affiliated Massachusetts General Hospital.

A heavy heart

Depression affects the entire body, not just the brain. It has been linked to low-grade inflammation, which is involved in the clogging of arteries and the rupture of cholesterol-filled plaque. Depression also boosts the production of stress hormones, which dull the response of the heart and arteries to demands for increased blood flow. It activates blood cell fragments known as platelets, making them more likely to clump and form clots in the bloodstream.

Many of the symptoms of depression—such as flagging energy levels and lack of motivation—can make getting regular exercise, eating healthy foods, and sticking to a medication regimen a real challenge. This, too, may help explain why depression makes heart disease more likely, says Dr. Celano.

After a heart attack—which is often when a person is first diagnosed with heart disease—it’s completely normal to feel moody, distressed, or irritable. Anxiety, which often goes hand in hand with depression, is common as well. People who undergo bypass surgery or a heart valve operation can take months to fully recover physically, and this stress also can take a toll on their mental health. People often have trouble sleeping and feel fatigued. But if those symptoms don’t gradually improve over time, they could be signs of depression, says Dr. Celano. (See “Do you have depression?”)

In 2014, an American Heart Association statement listed depression as a risk factor for a poor prognosis after a heart attack or unstable angina (chest pain at rest due to reduced blood flow to the heart). One study found that the risk of death in heart attack survivors with depression was three times that of those without depression.

Treating depression

If you think you have depression, your primary care provider is a good place to start. He or she may prescribe an antidepressant, most often a selective serotonin reuptake inhibitor (SSRI) such as sertraline (Zoloft), citalopram (Celexa), or escitalopram (Lexapro). These medications are considered safe and effective in people with depression and heart disease.

Talk therapy with a mental health provider can raise your odds of finding relief, although finding a good one who takes your health insurance and is accepting new patients can be a challenge. Ask your primary care doctor or your health insurance company for referrals. Call several practitioners to get on their waiting lists, if necessary, and be persistent, advises Dr. Celano.

Cardiac rehabilitation—a supervised program to help people recover after a heart attack or heart surgery—may also help combat depression. The structured exercise featured in these programs can help you start moving again, and exercise is a proven mood booster. Also, you’ll be in a group of people who understand what you’re going through, and this social support can help you feel less isolated and lonely.

Do you have depression?

The following two questions have proved useful for diagnosing depression in people with heart disease:

1. During the past month, have you often been bothered by feeling down, depressed, or hopeless?

2. During the past month, have you often been bothered by little interest or pleasure in doing things?

Answering “yes” to just one of those questions means you’re very likely to have depression.

Other common symptoms of depression include

  • lack of energy
  • loss of appetite (or unusual, persistent craving for food)
  • difficulty sleeping
  • feelings of worthlessness or loss of self-esteem
  • irritability throughout the day
  • excessive fatigue
  • loss of interest in sex.


This article was originally published by Harvard Health Publishing in November 2016.