Depression in Cardiac Patients

The Importance of Emotional Support

Written by KURA Guest Writer- Doris Lu-Anderson, PhD, E-RYT500, I-CAYT

Depression and heart disease are two infamous diseases and “hot topics” in the 21st century. Doctors and researchers have confirmed that these two diseases are connected. For example, Colberg et al. (2020) stated that depression is a primary cause of disability and often coexists heart disease.

Depression not only increases the risk of developing heart disease, but it also increases the risk of poor patient outcomes (e.g., mortality) among cardiac patients. Ziegelstein (n.d.) pointed out that some individuals with no previous depression record have become depressed after a heart attack or after developing heart failure. Also, likely, people with depression who don’t have a heart disease history are more likely to develop heart disease than the general population. Furthermore, Dr. Claire Sullivan stated that one out of five patients with heart disease experience depression or anxiety (University Hospitals, 2020).

From a mind and body perspective, there is a distinct connection between depression and heart disease. Nischala Joy Devi, a master yoga teacher who has a medical background and has been hosting Yoga of the Heart training for years, has observed many heart disease patients with depression. She said, “[The] Heart is an interesting organ. It seems like the heart has its energy that it does not want to be messed around with.” In yoga, the heart represents the heart energy wheel-Anahata Chakra. This is the space for people to hold love and compassion for others and themselves.

Psychological Impact of Heart Attack

Having a heart attack is a frightening experience for people. Not only will it attack the physical body, but it can also strike people’s emotions. Some behavior changes resulting from a heart attack may include:

• Changes in sleep (too much or too little)
• Difficulties concentrating, remembering details and making decisions
• Confidence about one’s ability to fulfill their role as an employee, a parent, or a child
• Embarrassment and self-doubt about one’s diminished physical capacities
• Fatigue or loss of energy
• Feelings of guilt about previous habits that might have triggered the heart attack
• Irritability
• Loss of interest in previously enjoyable activities
• Overeating or loss of appetite
• Restlessness
• Sense of uncertainty about the future
• Suicidal thoughts or attempts

(Colberg et al.; Ziegelstein)

The American Heart Association recommends screening for depression in all patients with heart disease. One reason for this screening is that many of the symptoms of depression overlap with those common in heart disease. During the screenings, qualified health professionals (e.g., physicians, psychologists) can formally diagnose depressive disorders. (Colberg et al.).

Bachmann et al. (2020) identified the stressors from cardiovascular disease differ by gender. Family responsibilities and job stress may contribute to a patient’s stressors. These stressors can manifest in people as fear, anger, social isolation, and a perceived burden to family and friends. Specifically, depression is noted as contributing to an increased risk of cardiovascular disease mortality and a higher chance of developing more adverse outcomes in women. The American Heart Association’s Go Red for Women and other associations such as National Heart, Lung, and Blood Institute (NHLBI) has campaigned to generate awareness of women’s cardiovascular health.

How to Reduce Depression and Brighten the Mood?

There are some popular practices to help people brighten their mood and feel happiness. For example:

• Develop a routine and stick to it as much as possible
• Embrace nature by going outdoors and getting into the sunlight
• Exercise
• Expressive Arts Therapy (e.g., art therapy, music therapy, sound healing, sand tray, drama therapy)
• Gentle yoga or stretching
• Journaling
• Meditation/Yoga Nidra (Yogic Sleep) or iRest (The modern adaptation of yoga Nidra which was founded by Dr. Richard Miller)
• Breathing techniques (e.g., Bellows breath, Breath of Joy, Unilateral right nostril breathing, Stairway Breath)
• Expressing gratitude (e.g., create a gratitude journal, write gratitude notes to others, take pictures of things you feel grateful for)
• Eat healthier
• Reward your efforts
• Seek help and talk to your doctor
• Spend time with loved ones
• Spend time with your pet
• Volunteer at local community organizations (e.g., church groups, animal shelters)

The Importance of Emotional Support

People need each other’s emotional support. Colberg et al. shared a report that patients who were socially isolated or who lacked a close confidant were more likely to die after a heart attack than those with adequate social support. Many cardiac patients also report that their interaction with staff and other patients is one of the most valued experiences during their cardiac rehab journey.

Cardiac patients and family members undergo a traumatic experience when an acute cardiac event strikes. Feelings of fear, guilt, anger, and sadness are all normal. Cardiac rehabilitation is a journey, which requires teamwork — the patient, family members, cardiac professionals, therapists, and friends, all working towards recovery and healing.

References

Colberg, S. R., Fletcher, E., Goldstein, C., Gordon, P. J., Hughes, J., Myers, J., Pack, Q. R., & Robinson, K. (2020). Modifiable CVD risk factors. In American Cardiovascular and Pulmonary Rehabilitation [AACPR](Eds.). Guidelines for cardiac rehabilitation programs (6th ed.) (pp.97–148). Human Kinetics.

Devi, N. J. (2017, October 1). Yoga of the Heart: Cardiac and cancer certification training. [Workshop training]. Yoga of the Heart, Soul of Yoga, Encinitas, CA, United States.

Machmann, J. M., Forman, D., Gauthier, N., Opotowsky, A., Supervia, M., & Terzi, C. (2020). Special demographic populations. Modifiable CVD risk factors. In American Cardiovascular and Pulmonary Rehabilitation [AACPR](Eds.). Guidelines for cardiac rehabilitation programs (6th ed.) (pp.197–222). Human Kinetics.

University Hospitals. (2020, February 10). Depression: Unexpected consequence of heart attack, heart surgery, or stroke. Retrieved from https://www.uhhospitals.org/Healthy-at-UH/articles/2020/02/depression-unexpected-consequence-of-heart-attack-heart-surgery-or-stroke

Ziegelstein, R. C. (n.d.). Depression and heart disease. Retrieved from https://www.hopkinsmedicine.org/heart_vascular_institute/centers_excellence/women_cardiovascular_health_center/patient_information/health_topics/depression_heart_disease.html