You may know that heart disease is the leading cause of death in Australia. But did you know that your mental health can affect your heart health and your heart health can affect your mental health?
Heart conditions such as heart attack and angina are also known as cardiovascular disease. These conditions often occur with anxiety or depression. In fact, we now know depression is a considerable risk factor for coronary heart disease along with smoking, high cholesterol and high blood pressure.
Depression can also affect how well people with heart disease recover, and increase their risk of further heart problems. So let's learn some more about the links between heart health and mental health.
What sorts of mental health conditions affect heart disease?
Anxiety and depression are both thought to relate to heart disease, both as a cause and an effect. So what are they?
Anxiety is a word we use to describe how we feel when we are worried or stressed. But it is more than that. Worry or stress will come and go; anxiety is a feeling that stays after the stressors have been removed. Everyone feels anxious from time to time, but for someone experiencing anxiety, these feelings can be difficult to control. Sometimes anxiety may have a single cause, but often there is no specific cause.
Depression is a constant feeling of dejection and loss, which stops you doing your normal activities. We can all feel sad or moody occasionally, but some people experience these feelings intensely, for long periods of time, and sometimes without any apparent cause.
Depression affects how you feel about yourself, and makes life more difficult to manage. You might lose interest in your work, hobbies, or doing things you would usually enjoy. You could lack energy, have trouble sleeping, sleep more than usual, feel irritable, or find it hard to concentrate.
Links between mental health and heart disease
So what are the links between heart health and mental health? Here are some links we know about:
- Depression is a significant independent risk factor for heart disease.
- Depression is linked with conventional risk factors for heart disease (such as an unhealthy lifestyle).
- Depression is common among people with heart disease. It affects recovery and increases the risk of further heart incidents. Heart attack patients with depression are often less motivated to follow healthy daily routines, which means they may skip important medication, avoid exercise and proper diet, and continue harmful behaviours such as smoking and drinking alcohol.
- Recent studies show anxiety may also be a risk factor for heart disease.
How can a heart attack affect your mental health?
A heart attack can affect people in many ways. Having a heart attack can affect your attitude and mood. You might feel lucky to be alive and that you have had a wake-up call. You may feel uncertain about the future and anxious about your long-term health. You may be less confident, or embarrassed or frustrated because you can't do as much. And it's not uncommon to feel guilty about things you've done in the past that might have led to the heart attack.
Symptoms of depression
Feeling down for a little while is to be expected, but if these feelings last longer than a couple of weeks, you could have depression:
- feeling sad or irritable
- feeling empty, hopeless, guilty, or worthless
- a loss of pleasure in activities you usually enjoy
- fatigue and decreased energy
- trouble concentrating, remembering details, and making decisions
- difficulty sleeping, or sleeping too much
- overeating, or not wanting to eat at all
- losing weight or gaining weight
- thoughts of death or suicide, or suicide attempts
- aches or pains, headaches, cramps or digestive problems without a clear physical cause
- finding it difficult to manage everyday life.
If you don't have the same zest for life you did before your heart attack, it is important not to dismiss those feelings as a normal part of having a chronic illness.
Symptoms of anxiety
Living with heart disease or having a heart attack can trigger anxiety. Anxiety is more than just feeling stressed. You may be experiencing anxiety if you:
- feel worried most of the time
- find it difficult to calm down
- have recurring thoughts that increase your anxiety
- avoid situations that may cause you to be anxious
- experience intense fear or panic
- experience physical effects such as trembling, sweating, faintness, rapid heartbeat, difficulties breathing or nausea.
Remember, effective treatment is available for depression and anxiety, no matter what their cause.
Diagnosis of depression in people with heart disease
Diagnosing depression in people with heart disease is not always easy, because symptoms of depression, such as tiredness and low energy levels, are shared with heart disease or can be side effects of medication used to treat heart conditions.
Doctors can screen for depression using questionnaires or interviews that address the symptoms of depression. Screening for depression should occur during your first visit to your GP for coronary heart disease, and at your next follow-up visit. If you have a major heart event such as a heart attack it is recommended that you be screened at two to three months after that event, and then on a yearly basis.
This type of screening will help to detect any depression early so you can have treatment and improve both your mental and physical health.
Treatment for depression in people with heart disease
Depression is treatable, so it is important to ask for help early if you think you have symptoms of depression or anxiety.
An important step is to ask your doctor or cardiac rehabilitation team for help. They can screen for depression and then recommend treatment that suits you and your situation.
Support for people with depression and heart disease can include:
- care from a team of healthcare professionals working in collaboration
- exercise -- ask your doctor for advice about physical activities that are suitable for you
- psychological therapy ('talking therapy') that focuses on building skills to deal with your life stresses and to change negative thinking patterns
- antidepressant medication -- depending on what other medication you are taking.
It can take up to six weeks to feel better after starting antidepressant medication, but most people will notice an improvement sooner. Treating your depression will also make it easier for you to make some of the lifestyle changes that are important for your health or recovery.
Depending on your abilities, lifestyle changes to improve your physical and mental health may include:
- exercising regularly
- eating healthy food
- reducing alcohol intake
- practising relaxation techniques
- doing enjoyable activities.
Where to get help
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